Provider Demographics
NPI:1982857355
Name:BURNETT, HEATHER JOY (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:JOY
Last Name:BURNETT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 DUMAS HILL RD
Mailing Address - Street 2:
Mailing Address - City:PORT CRANE
Mailing Address - State:NY
Mailing Address - Zip Code:13833-1639
Mailing Address - Country:US
Mailing Address - Phone:607-427-4637
Mailing Address - Fax:
Practice Address - Street 1:115 DUMAS HILL RD
Practice Address - Street 2:
Practice Address - City:PORT CRANE
Practice Address - State:NY
Practice Address - Zip Code:13833
Practice Address - Country:US
Practice Address - Phone:607-427-4637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010489-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics