Provider Demographics
NPI:1942370325
Name:HEATH, JODELLE L (MS OTR)
Entity Type:Individual
Prefix:
First Name:JODELLE
Middle Name:L
Last Name:HEATH
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:
Other - First Name:JODELLE
Other - Middle Name:L
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR
Mailing Address - Street 1:200 PAIGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045
Mailing Address - Country:US
Mailing Address - Phone:603-384-1004
Mailing Address - Fax:
Practice Address - Street 1:2 PILLSBURY STREET
Practice Address - Street 2:SUITE 404
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3549
Practice Address - Country:US
Practice Address - Phone:603-228-7827
Practice Address - Fax:603-228-7828
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1712225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30876YMedicare UPIN