Provider Demographics
NPI:1023463619
Name:MOGIELNICKI, HEATHER (OT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MOGIELNICKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:WILKENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:111 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06019-3182
Mailing Address - Country:US
Mailing Address - Phone:860-404-2587
Mailing Address - Fax:
Practice Address - Street 1:140 WILLOW ST
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:CT
Practice Address - Zip Code:06098-2092
Practice Address - Country:US
Practice Address - Phone:860-738-5810
Practice Address - Fax:860-738-5820
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002276225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist