Provider Demographics
NPI:1902044894
Name:DAVIDSON, HEATHER M (CO)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:M
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 CRUTCHFIELD ST
Mailing Address - Street 2:BIO-TECH PROSTHETICS AND ORTHOTICS
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2725
Mailing Address - Country:US
Mailing Address - Phone:919-471-4994
Mailing Address - Fax:919-471-4995
Practice Address - Street 1:314 CRUTCHFIELD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2725
Practice Address - Country:US
Practice Address - Phone:919-471-4994
Practice Address - Fax:919-471-4995
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795428Medicaid