Provider Demographics
NPI:1942955463
Name:PANTHER, HEIDI
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:PANTHER
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 1:7802 MARKER RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-8229
Mailing Address - Country:US
Mailing Address - Phone:240-626-3577
Mailing Address - Fax:
Practice Address - Street 1:362 CHRISTOPHER AVE STE A
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3613
Practice Address - Country:US
Practice Address - Phone:240-410-3209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2024-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026346225X00000X
MD10390225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist