Provider Demographics
NPI:1942368477
Name:HAIDER, HEATHER MICHELLE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MICHELLE
Last Name:HAIDER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 HIGHWAY 96 W
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-1960
Mailing Address - Country:US
Mailing Address - Phone:763-784-3269
Mailing Address - Fax:
Practice Address - Street 1:14663 MERCANTILE DR N
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038-4559
Practice Address - Country:US
Practice Address - Phone:651-407-3777
Practice Address - Fax:651-407-7064
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist