Provider Demographics
NPI:1649503210
Name:BRUDERECK, HEATHER ANN (MSORT/L)
Entity type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:ANN
Last Name:BRUDERECK
Suffix:
Gender:F
Credentials:MSORT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 TEL HAI CIR
Mailing Address - Street 2:
Mailing Address - City:HONEY BROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19344-1271
Mailing Address - Country:US
Mailing Address - Phone:610-273-9333
Mailing Address - Fax:610-273-3890
Practice Address - Street 1:1200 TEL HAI CIR
Practice Address - Street 2:
Practice Address - City:HONEY BROOK
Practice Address - State:PA
Practice Address - Zip Code:19344-1271
Practice Address - Country:US
Practice Address - Phone:610-273-9333
Practice Address - Fax:610-273-3890
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010776225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist