Individual
OTIS HEAVENRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
785 ALAMEDA AVE, ASTORIA, OR 97103-5947
(503) 338-8225
Mailing address
35218 MUDD LN, ASTORIA, OR 97103-8337
(503) 338-8225
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
14050779
OR
Other
Enumeration date
02/14/2024
Last updated
02/14/2024
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