Provider Demographics
NPI:1619376449
Name:WELCH, HEATHER M (COTA)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:M
Last Name:WELCH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 TIMOTHY DR
Mailing Address - Street 2:
Mailing Address - City:SCHUYLERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12871-1400
Mailing Address - Country:US
Mailing Address - Phone:518-955-4173
Mailing Address - Fax:
Practice Address - Street 1:13 TIMOTHY DR
Practice Address - Street 2:
Practice Address - City:SCHUYLERVILLE
Practice Address - State:NY
Practice Address - Zip Code:12871-1400
Practice Address - Country:US
Practice Address - Phone:518-955-4173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT073.0099201224Z00000X
NY008174-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant