Provider Demographics
NPI:1891440574
Name:HERON, SIOMARA A (OT)
Entity Type:Individual
Prefix:MS
First Name:SIOMARA
Middle Name:A
Last Name:HERON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11953 228TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-2133
Mailing Address - Country:US
Mailing Address - Phone:917-355-6269
Mailing Address - Fax:
Practice Address - Street 1:11953 228TH ST
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-2133
Practice Address - Country:US
Practice Address - Phone:917-355-6269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63009086225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist