Provider Demographics
NPI:1265071625
Name:RICHTER, HEIDI (OTR/L)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:RICHTER
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 1:966 BARTNICK RD
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:NY
Mailing Address - Zip Code:13071-9764
Mailing Address - Country:US
Mailing Address - Phone:315-209-2404
Mailing Address - Fax:
Practice Address - Street 1:150 W END AVE APT 1M
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5715
Practice Address - Country:US
Practice Address - Phone:212-600-4781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024343-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist