Healthcare Provider Details

I. General information

NPI: 1023653599
Provider Name (Legal Business Name): HEIDI MOY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15327 88TH AVE
JAMAICA NY
11432-3831
US

IV. Provider business mailing address

66 WALTER DR
STONY POINT NY
10980-1041
US

V. Phone/Fax

Practice location:
  • Phone: 718-298-7700
  • Fax:
Mailing address:
  • Phone: 845-304-6535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0216901
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: