Provider Demographics
NPI:1508012394
Name:PANCZYKOWSKI, HEATHER LYNN (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:PANCZYKOWSKI
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 FOREST ACRES DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6657
Mailing Address - Country:US
Mailing Address - Phone:716-465-9476
Mailing Address - Fax:
Practice Address - Street 1:1503 FOREST ACRES DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6657
Practice Address - Country:US
Practice Address - Phone:716-465-9476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005358-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist