Provider Demographics
NPI:1982835963
Name:BLOECHLE, HEATHER JOYCE (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:HEATHER
Middle Name:JOYCE
Last Name:BLOECHLE
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 1:4 SUMMIT RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1485
Mailing Address - Country:US
Mailing Address - Phone:203-440-3650
Mailing Address - Fax:
Practice Address - Street 1:4 SUMMIT RD
Practice Address - Street 2:SUITE C
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1485
Practice Address - Country:US
Practice Address - Phone:203-440-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001005224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant