Basic Information
Provider Information
NPI: 1477195725
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HEDDENS
FirstName: CHELSEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OTR
OtherOrganizationName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 500 CROSS ST
Address2:  
City: BIG STONE CITY
State: SD
PostalCode: 572168237
CountryCode: US
TelephoneNumber: 6055411147
FaxNumber: 6055410109
Practice Location
Address1: 66 E SAINT MARIE ST
Address2:  
City: DULUTH
State: MN
PostalCode: 558032646
CountryCode: US
TelephoneNumber: 2184817603
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/08/2019
LastUpdateDate: 11/12/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/12/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X105984MNY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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