Healthcare Provider Details

I. General information

NPI: 1053064600
Provider Name (Legal Business Name): KATELYN HEUSER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 FROEHLICH FARM RD
HICKSVILLE NY
11801-3406
US

IV. Provider business mailing address

74 FROEHLICH FARM RD
HICKSVILLE NY
11801-3406
US

V. Phone/Fax

Practice location:
  • Phone: 516-603-0916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: