Provider Demographics
NPI:1508211053
Name:LEWIS, HEIDI MELISSA (COTA)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:MELISSA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BEACON HILL RD
Mailing Address - Street 2:APT G
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-1255
Mailing Address - Country:US
Mailing Address - Phone:973-728-3813
Mailing Address - Fax:
Practice Address - Street 1:50 BEACON HILL RD
Practice Address - Street 2:APT G
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-1255
Practice Address - Country:US
Practice Address - Phone:973-907-3981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004844-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant