Provider Demographics
NPI:1609360981
Name:INESON, HEATHER L
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:L
Last Name:INESON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-2303
Mailing Address - Country:US
Mailing Address - Phone:914-584-4278
Mailing Address - Fax:
Practice Address - Street 1:33 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-2303
Practice Address - Country:US
Practice Address - Phone:914-584-4278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017137-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY017137-1OtherOCCUPATIONAL THERAPY LICENCE