MEDICARE: MRS. HEATHER JOY BURNETT 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	225XP0200X	Pediatric Occupational Therapist	010489-1	NY

General Provider Information

NPI Number	:	1982857355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER JOY BURNETT OTR/L

Provider Business Mailing Address
First Line	:	115 DUMAS HILL RD
Second Line	:
City	:	PORT CRANE
State	:	NY
Zip	:	13833-1639
Country	:	US
Telephone Number	:	607-427-4637
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 DUMAS HILL RD
Second Line	:
City	:	PORT CRANE
State	:	NY
Zip	:	13833
Country	:	US
Telephone Number	:	607-427-4637
Fax Number	:

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

Provider Enumeration Date	:	10/29/2008
Last Update Date	:	09/01/2011

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Directions to “ MRS. HEATHER JOY BURNETT OTR/L” Practice Location

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