Provider Demographics
NPI:1548413065
Name:BEACH, HEATHER M (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:M
Last Name:BEACH
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 1:4 HARVARD PL
Mailing Address - Street 2:APT A
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-5431
Mailing Address - Country:US
Mailing Address - Phone:412-951-3397
Mailing Address - Fax:
Practice Address - Street 1:4 HARVARD PL
Practice Address - Street 2:APT A
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-5431
Practice Address - Country:US
Practice Address - Phone:412-951-3397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006465224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant