Provider Demographics
NPI:1639847122
Name:BURAKOWSKI, HEATHER (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:BURAKOWSKI
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CRYSTAL RUN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-7010
Mailing Address - Country:US
Mailing Address - Phone:845-692-4391
Mailing Address - Fax:
Practice Address - Street 1:9 MURRAY RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD LAKE
Practice Address - State:NY
Practice Address - Zip Code:10925-2121
Practice Address - Country:US
Practice Address - Phone:845-548-8215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010855224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant