Provider Demographics
NPI:1609986587
Name:MACROY-COPPOLA, HEATHER ANNE (OTR L CHT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:MACROY-COPPOLA
Suffix:
Gender:F
Credentials:OTR L CHT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ANNE
Other - Last Name:MACROY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR L CHT
Mailing Address - Street 1:2416 CONSTITUTION AVE
Mailing Address - Street 2:REHABILITATION TODAY
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760
Mailing Address - Country:US
Mailing Address - Phone:716-372-2808
Mailing Address - Fax:716-372-2902
Practice Address - Street 1:2416 CONSTITUTION AVE
Practice Address - Street 2:REHABILITATION TODAY
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760
Practice Address - Country:US
Practice Address - Phone:716-372-2808
Practice Address - Fax:716-372-2902
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009006225X00000X
PAOC006612225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB1916816Medicaid
NYBB6044Medicare ID - Type Unspecified
NYB1916816Medicaid