Provider Demographics
NPI:1720336720
Name:MCCLURE, HEATHER KAUFMAN (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:KAUFMAN
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:TROUT LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98650-0303
Mailing Address - Country:US
Mailing Address - Phone:409-502-0018
Mailing Address - Fax:
Practice Address - Street 1:418 NE TOHOMISH ST #300
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672
Practice Address - Country:US
Practice Address - Phone:409-502-0018
Practice Address - Fax:360-524-7872
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-22
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR241655225XP0200X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics