Provider Demographics
NPI:1881151470
Name:SELLERS, HEIDI ANNE (DT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANNE
Last Name:SELLERS
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 GLENDALE CT
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:IN
Mailing Address - Zip Code:47143-9480
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2916 GLENDALE CT
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:IN
Practice Address - Zip Code:47143-9480
Practice Address - Country:US
Practice Address - Phone:502-664-9409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist