Provider Demographics
NPI:1710468558
Name:HERON, MICHELE MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARIE
Last Name:HERON
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 1:9 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-3229
Mailing Address - Country:US
Mailing Address - Phone:978-423-9053
Mailing Address - Fax:
Practice Address - Street 1:1 STILES RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-4859
Practice Address - Country:US
Practice Address - Phone:855-390-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant