Provider Demographics
NPI:1255541991
Name:BALDAUFF, HEATHER (HEATHER BALDAUFF OT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BALDAUFF
Suffix:
Gender:F
Credentials:HEATHER BALDAUFF OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5085 PLUMOSA ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34607-2478
Mailing Address - Country:US
Mailing Address - Phone:352-281-7857
Mailing Address - Fax:
Practice Address - Street 1:800 SOUTH LOWER SACRAMENTO ROAD
Practice Address - Street 2:LODI MEMORIAL HOSPITAL WEST
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242
Practice Address - Country:US
Practice Address - Phone:209-334-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9179225X00000X
AZ3372225X00000X
TN3090225X00000X
OR1064567225X00000X
AK1736225X00000X
NM2256225X00000X
VA0119004159225X00000X
FL12092225X00000X
RI01056225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist