1760709067 NPI number — HEIDI ELIZABETH KEPPLER M.ED., BCBA

Table of content: HEIDI ELIZABETH KEPPLER M.ED., BCBA (NPI 1760709067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760709067 NPI number — HEIDI ELIZABETH KEPPLER M.ED., BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEPPLER
Provider First Name:
HEIDI
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED., BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIGHT
Provider Other First Name:
HEIDI
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., BCBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760709067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
253 IRON LAKE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19341-2774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-943-1733
Provider Business Mailing Address Fax Number:
484-872-8702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
253 IRON LAKE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EXTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19341-2774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-943-1733
Provider Business Practice Location Address Fax Number:
484-872-8702
Provider Enumeration Date:
04/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-06-2865 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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