Provider Demographics
NPI:1801280441
Name:STODDARD, HEIDI (OTR)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:STODDARD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:BRECKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:815 NW 9TH STREET
Mailing Address - Street 2:SUITE180
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6173
Mailing Address - Country:US
Mailing Address - Phone:541-768-5157
Mailing Address - Fax:541-768-5080
Practice Address - Street 1:815 NW 9TH STREET
Practice Address - Street 2:SUITE180
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6173
Practice Address - Country:US
Practice Address - Phone:541-768-5157
Practice Address - Fax:541-768-5080
Is Sole Proprietor?:No
Enumeration Date:2015-03-21
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR337948225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist