Provider Demographics
NPI:1336238278
Name:MCCLELLAN, HEATHER E (LPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:E
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 67TH STREET
Mailing Address - Street 2:#106
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266
Mailing Address - Country:US
Mailing Address - Phone:515-440-2044
Mailing Address - Fax:
Practice Address - Street 1:CENTRAL REHABILITATION, LTD
Practice Address - Street 2:950 OFFICE PARK ROAD, SUITE 100
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265
Practice Address - Country:US
Practice Address - Phone:515-224-0979
Practice Address - Fax:515-223-3862
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03411174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist