Provider Demographics
NPI:1942453311
Name:WOODRUFF, HEIDI ANN (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:HEIDI
Middle Name:ANN
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 MOUNTAIN VALLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:HALLSTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:18822
Mailing Address - Country:US
Mailing Address - Phone:607-761-3487
Mailing Address - Fax:570-879-8824
Practice Address - Street 1:616 MOUNTAIN VALLEY RD
Practice Address - Street 2:
Practice Address - City:HALLSTEAD
Practice Address - State:PA
Practice Address - Zip Code:18822
Practice Address - Country:US
Practice Address - Phone:607-761-3487
Practice Address - Fax:570-879-8824
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006276224Z00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant