Provider Demographics
NPI:1679788970
Name:GALE, HEATHER ANN (OTR)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANN
Last Name:GALE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ANN
Other - Last Name:ROBERGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 HORTON ST
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2911
Mailing Address - Country:US
Mailing Address - Phone:978-834-6119
Mailing Address - Fax:
Practice Address - Street 1:112 SOHIER RD
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5534
Practice Address - Country:US
Practice Address - Phone:978-232-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6797225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6797OtherLICENSURE NUMBER