Provider Demographics
NPI:1346474665
Name:CLIFORD, HEATHER (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:
Last Name:CLIFORD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 FIRST AVE
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1334
Mailing Address - Country:US
Mailing Address - Phone:800-590-2691
Mailing Address - Fax:800-590-2706
Practice Address - Street 1:1150 FIRST AVE
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1334
Practice Address - Country:US
Practice Address - Phone:800-590-2691
Practice Address - Fax:800-590-2706
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU2-0001105224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant