Provider Demographics
NPI:1588818520
Name:HEIDT, ERICA L (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:L
Last Name:HEIDT
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 1:88 ELWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3459
Mailing Address - Country:US
Mailing Address - Phone:631-239-5880
Mailing Address - Fax:631-239-1822
Practice Address - Street 1:88 ELWOOD RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3459
Practice Address - Country:US
Practice Address - Phone:631-239-5880
Practice Address - Fax:631-239-1822
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015303-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics