Provider Demographics
NPI:1659495406
Name:HECKER, MARY LISA (OTR)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LISA
Last Name:HECKER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2074 VALLEY VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-2059
Mailing Address - Country:US
Mailing Address - Phone:619-262-7342
Mailing Address - Fax:619-262-8918
Practice Address - Street 1:1110 CAROLINA LANE
Practice Address - Street 2:RM. 206
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-3626
Practice Address - Country:US
Practice Address - Phone:619-262-7342
Practice Address - Fax:619-262-8918
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0530012225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner