Provider Demographics
NPI:1356213144
Name:STRUBLE, HEATHER R
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:STRUBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:R
Other - Last Name:HAINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1468 E PARKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529-1634
Mailing Address - Country:US
Mailing Address - Phone:989-778-8176
Mailing Address - Fax:
Practice Address - Street 1:1468 E PARKWOOD AVE
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529-1634
Practice Address - Country:US
Practice Address - Phone:989-778-8176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225800000X, 226000000X, 376J00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No226000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreational Therapist Assistant
No376J00000XNursing Service Related ProvidersHomemaker