Provider Demographics
NPI:1700420080
Name:HEFFNER, NICOLE OLIVIA (MSOTR/L BSHS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:OLIVIA
Last Name:HEFFNER
Suffix:
Gender:F
Credentials:MSOTR/L BSHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2453 KINGSTON CT STE 101
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-3655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 CHAMBERS HILL DR STE 101
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-7304
Practice Address - Country:US
Practice Address - Phone:717-709-7930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
423608OtherNBCOT CERTIFICATION NUMBER