Provider Demographics
NPI:1902035579
Name:VAN CLEAVE, HEATHER A (LMT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:VAN CLEAVE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2824
Mailing Address - Country:US
Mailing Address - Phone:503-544-4546
Mailing Address - Fax:
Practice Address - Street 1:200 E HANCOCK ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2824
Practice Address - Country:US
Practice Address - Phone:503-544-4546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-04
Last Update Date:2009-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16105225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist