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GAYLENE HEATON OT-SC



Provider NPI: 1740701614

Provider Information:
 GAYLENE  HEATON OT-SC
Gender: F
Not Sole Proprietor

Practice Location:
502 COPPER ST STE 5  HURLEY, WI 54534-1386 US
Tel: 715-563-0092  Fax: --

Business Mailing Address:
14337N STATELINE RD  HURLEY, WI 54534 US
Tel: 715-360-1250  Fax: --

NPI Information:
NPI: 1740701614
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N246ZX2200X

16-1140
Y246ZC0007XTechnologists, Technicians & Other Technical Service Providers
Specialist/Technologist, Other
17-2770

Other Provider Identifiers:

IssuerNumberStateType



American Medical Association 2012 taxonomy code information

Code: 246ZC0007X

Type:

Classification:



Definition:



MEDICAL JOBS WI - Page 1

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