Provider Demographics
NPI:1366587834
Name:CLIFFORD, HEIDI ELLEN (OT L)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:ELLEN
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:OT L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 34TH AVE # 427
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3969
Mailing Address - Country:US
Mailing Address - Phone:907-205-4366
Mailing Address - Fax:877-409-9161
Practice Address - Street 1:505 W NORTHERN LIGHTS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2552
Practice Address - Country:US
Practice Address - Phone:907-205-4366
Practice Address - Fax:877-409-9161
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK479225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOT8794Medicaid