Provider Demographics
NPI:1124807995
Name:HEGGSTROM, HOBIE (CPO)
Entity type:Individual
Prefix:
First Name:HOBIE
Middle Name:
Last Name:HEGGSTROM
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 WELLSIAN WAY
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4116
Mailing Address - Country:US
Mailing Address - Phone:509-943-8561
Mailing Address - Fax:509-572-9192
Practice Address - Street 1:317 WELLSIAN WAY
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4116
Practice Address - Country:US
Practice Address - Phone:509-943-8561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPS61406882224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist