Provider Demographics
NPI:1588808612
Name:BEDNARZ, HEATHER THERESA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:THERESA
Last Name:BEDNARZ
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 1:1157 NEW ST
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:PA
Mailing Address - Zip Code:18434-1721
Mailing Address - Country:US
Mailing Address - Phone:570-677-4093
Mailing Address - Fax:
Practice Address - Street 1:1157 NEW ST
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:PA
Practice Address - Zip Code:18434-1721
Practice Address - Country:US
Practice Address - Phone:706-774-0935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA07262492225X00000X
PAOC010617225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist