Organization
INTEGRATIVE WELLNESS AND THERAPEUTICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA HEIDENREICH OTD (OWNER, CEO)
(843) 267-3361
Entity
Organization
Contact information
Practice address
19901 W CATAWBA AVE STE 104, CORNELIUS, NC 28031-4040
(704) 610-8250
Mailing address
19901 W CATAWBA AVE STE 104, CORNELIUS, NC 28031-4040
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
—
—
224Z00000X
Occupational Therapy Assistant
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
01/10/2022
Last updated
01/10/2022
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