Healthcare Provider Details

I. General information

NPI: 1619279148
Provider Name (Legal Business Name): TAMMY VICTORIA HEISER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2010
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 STATE HIGHWAY 67
JOHNSTOWN NY
12095-3747
US

IV. Provider business mailing address

323 CANAL ST
FORT PLAIN NY
13339-1160
US

V. Phone/Fax

Practice location:
  • Phone: 518-736-4681
  • Fax:
Mailing address:
  • Phone: 518-993-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number011330-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: