Provider Demographics
NPI:1235444944
Name:MOULTON, HEATHER JANE (OT)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:JANE
Last Name:MOULTON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3157
Mailing Address - Country:US
Mailing Address - Phone:908-561-6570
Mailing Address - Fax:908-755-3329
Practice Address - Street 1:101 CEDAR GROVE LN
Practice Address - Street 2:SUITE C
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-4700
Practice Address - Country:US
Practice Address - Phone:732-356-5363
Practice Address - Fax:732-356-5364
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00116800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist