Provider Demographics
NPI:1619279148
Name:HEISER, TAMMY VICTORIA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:VICTORIA
Last Name:HEISER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:FORT PLAIN
Mailing Address - State:NY
Mailing Address - Zip Code:13339-1160
Mailing Address - Country:US
Mailing Address - Phone:518-993-2111
Mailing Address - Fax:
Practice Address - Street 1:2755 STATE HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-3747
Practice Address - Country:US
Practice Address - Phone:518-736-4681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-05
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011330-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics