Active NPI
Daniel Paul Heatherly, D.O.
- Pediatrics Physician
- Canton, OH
National Provider Identifier
1194050716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 010769
- Practice address
- 919 2ND St NE
Canton, OH 44704-1132 - Phone
- (330) 453-3386
- NPI assigned
- Oct 15, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 010769 | OH | Primary |
Addresses
Primary practice location
919 2ND St NE
Canton, OH 44704-1132
Mailing address
919 2ND St NE
Canton, OH 44704-1132
Phone (330) 453-3386
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0077444 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010769 | OH | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255564800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463443200000",
"number": "1194050716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "919 2ND ST NE",
"city": "CANTON",
"state": "OH",
"postal_code": "447041132",
"telephone_number": "330-453-3386"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "919 2ND ST NE",
"city": "CANTON",
"state": "OH",
"postal_code": "447041132",
"telephone_number": "330-453-3386"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEATHERLY",
"first_name": "DANIEL",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-10-15",
"last_updated": "2016-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "010769",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0077444",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.