Provider Demographics
NPI:1831734128
Name:AUTHENTIC HAND THERAPY LLC
Entity type:Organization
Organization Name:AUTHENTIC HAND THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L CHT
Authorized Official - Phone:248-219-7053
Mailing Address - Street 1:724 S CENTRAL AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-7808
Mailing Address - Country:US
Mailing Address - Phone:248-219-7053
Mailing Address - Fax:
Practice Address - Street 1:724 S CENTRAL AVE STE 107
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7808
Practice Address - Country:US
Practice Address - Phone:248-219-7053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-11
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty