Provider Demographics
NPI:1336417757
Name:HEIL, LAURA A (BS OTR)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:HEIL
Suffix:
Gender:F
Credentials:BS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 RAMSEY DR
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3015
Mailing Address - Country:US
Mailing Address - Phone:908-277-4376
Mailing Address - Fax:
Practice Address - Street 1:151 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2813
Practice Address - Country:US
Practice Address - Phone:908-598-0228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00471600225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics