Provider Demographics
NPI:1891921060
Name:WALBORN, HEATHER M (OTR)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:WALBORN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9190 PRIORITY WAY WEST DR STE 110
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1437
Mailing Address - Country:US
Mailing Address - Phone:317-805-4963
Mailing Address - Fax:317-818-0720
Practice Address - Street 1:9190 PRIORITY WAY WEST DR STE 110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1437
Practice Address - Country:US
Practice Address - Phone:317-805-4963
Practice Address - Fax:317-818-0720
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004597A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist