Provider Demographics
NPI:1568617009
Name:FIACCO, HEATHER FAWN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:FAWN
Last Name:FIACCO
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 1:5300 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1903
Mailing Address - Country:US
Mailing Address - Phone:716-298-2253
Mailing Address - Fax:716-298-2471
Practice Address - Street 1:5300 MILITARY RD
Practice Address - Street 2:MT. ST. MARY'S HOSPITAL ROOM 526
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1903
Practice Address - Country:US
Practice Address - Phone:716-298-2253
Practice Address - Fax:716-298-2471
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005621F224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant