Provider Demographics
NPI:1386375335
Name:HEPPLE, LAURA (ATC, LAT, CES, BDLS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HEPPLE
Suffix:
Gender:F
Credentials:ATC, LAT, CES, BDLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11516 HIGHWAY 79 S
Mailing Address - Street 2:
Mailing Address - City:HENRY
Mailing Address - State:TN
Mailing Address - Zip Code:38231-3694
Mailing Address - Country:US
Mailing Address - Phone:731-273-9193
Mailing Address - Fax:
Practice Address - Street 1:11516 HIGHWAY 79 S
Practice Address - Street 2:
Practice Address - City:HENRY
Practice Address - State:TN
Practice Address - Zip Code:38231-3694
Practice Address - Country:US
Practice Address - Phone:731-273-9193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2142OtherTN STATE LIVENSE