MEDICARE: HEATHER LYNN PANCZYKOWSKI MS, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	005358-1	NY

General Provider Information

NPI Number	:	1508012394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER LYNN PANCZYKOWSKI MS, OTR/L

Provider Business Mailing Address
First Line	:	1503 FOREST ACRES DR
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-6657
Country	:	US
Telephone Number	:	716-465-9476
Fax Number	:

Provider Business Practice Location Address
First Line	:	1503 FOREST ACRES DR
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-6657
Country	:	US
Telephone Number	:	716-465-9476
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	03/04/2024

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