Provider Demographics
NPI:1891914297
Name:BURNS-HEAGNEY, NANCY ELIZABETH (OT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ELIZABETH
Last Name:BURNS-HEAGNEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ELIZABETH
Other - Last Name:JOBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:585 KINGSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3600
Mailing Address - Country:US
Mailing Address - Phone:401-284-4357
Mailing Address - Fax:401-284-4358
Practice Address - Street 1:585 KINGSTOWN RD
Practice Address - Street 2:
Practice Address - City:SOUTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02879-3600
Practice Address - Country:US
Practice Address - Phone:401-284-4357
Practice Address - Fax:401-284-4358
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI0T00272225X00000X
RIMHC01371101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RINB45127Medicaid