Provider Demographics
NPI:1669535126
Name:DOLAN, HEATHER L (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:L
Last Name:DOLAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:ARC WAYNE/ROOSEVELT CHILDRENS CENTER
Mailing Address - Street 2:848 PEIRSON AVENUE
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513
Mailing Address - Country:US
Mailing Address - Phone:315-331-2086
Mailing Address - Fax:315-331-3215
Practice Address - Street 1:ROOSEVELT CHILDRENS CENTER
Practice Address - Street 2:848 PIERSON AVENUE
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513
Practice Address - Country:US
Practice Address - Phone:315-331-2086
Practice Address - Fax:315-331-3215
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010354-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist