Provider Demographics
NPI:1184077851
Name:HEATHER HEALY
Entity type:Organization
Organization Name:HEATHER HEALY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:BICKFORD
Authorized Official - Last Name:HEALY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:415-819-7267
Mailing Address - Street 1:507 GORDON CT
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-1324
Mailing Address - Country:US
Mailing Address - Phone:415-819-7267
Mailing Address - Fax:
Practice Address - Street 1:507 GORDON CT
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-1324
Practice Address - Country:US
Practice Address - Phone:415-819-7267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3963282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital