Provider Demographics
NPI:1326116963
Name:EDWARDS, HEATHER (OT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:EDWARDS
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 1:240 COLONY ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5205
Mailing Address - Country:US
Mailing Address - Phone:203-292-8452
Mailing Address - Fax:203-292-8456
Practice Address - Street 1:240 COLONY ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5205
Practice Address - Country:US
Practice Address - Phone:203-292-8452
Practice Address - Fax:203-292-8456
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003071225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist