Provider Demographics
NPI:1457042129
Name:CHAMBERLAIN, HEATHER (RN, PTA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:RN, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3781 S SALT LICK CIR
Mailing Address - Street 2:
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-2366
Mailing Address - Country:US
Mailing Address - Phone:801-628-5843
Mailing Address - Fax:
Practice Address - Street 1:11 E 200 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4737
Practice Address - Country:US
Practice Address - Phone:801-226-1919
Practice Address - Fax:801-224-4081
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8350208-2402225200000X
UT8350208-3102163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant