Provider Demographics
NPI:1760362578
Name:HUBBARD, HEAVEN
Entity type:Individual
Prefix:
First Name:HEAVEN
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CEDAR BRANCH CIR
Mailing Address - Street 2:
Mailing Address - City:ODENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35120-2025
Mailing Address - Country:US
Mailing Address - Phone:205-729-1808
Mailing Address - Fax:205-989-9903
Practice Address - Street 1:115 CEDAR BRANCH CIR
Practice Address - Street 2:
Practice Address - City:ODENVILLE
Practice Address - State:AL
Practice Address - Zip Code:35120-2025
Practice Address - Country:US
Practice Address - Phone:205-729-1808
Practice Address - Fax:205-989-9903
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4886227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Single Specialty