Provider Demographics
NPI:1740646314
Name:HECKMAN, MARIANNE RAE (PTA)
Entity type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:RAE
Last Name:HECKMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:MARIANNE
Other - Middle Name:RAE
Other - Last Name:MAULDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1021 HARRISON DR
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-1617
Mailing Address - Country:US
Mailing Address - Phone:701-833-5097
Mailing Address - Fax:844-272-1182
Practice Address - Street 1:1715 S BROADWAY
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6304
Practice Address - Country:US
Practice Address - Phone:701-837-8441
Practice Address - Fax:844-272-1182
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND0648171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor