Provider Demographics
NPI:1306440953
Name:MODERN ALCHEMY INTEGRATIVE WOMEN'S HEALTH, PLLC
Entity type:Organization
Organization Name:MODERN ALCHEMY INTEGRATIVE WOMEN'S HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TRUOG
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:269-760-7867
Mailing Address - Street 1:119 SHOREVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-6611
Mailing Address - Country:US
Mailing Address - Phone:269-760-7867
Mailing Address - Fax:
Practice Address - Street 1:220A E FRONT ST
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-2146
Practice Address - Country:US
Practice Address - Phone:252-626-4401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty