OTIS HEAVENRICH

ASTORIA, OR
NPI1518722016
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy235Z00000X Speech-Language Pathologist,
(Licence: OR  14050779)
Enumeration Date2024-02-14
Last Update Date2024-02-14
Business Address
OTIS HEAVENRICH
785 ALAMEDA AVE
ASTORIA, OR 97103-5947
Phone number: 503-338-8225
Mailing Address
OTIS HEAVENRICH
35218 MUDD LN
ASTORIA, OR 97103-8337
Phone number: 503-338-8225
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