Healthcare Provider Details

I. General information

NPI: 1639083272
Provider Name (Legal Business Name): AUSTIN JAMES HEBART OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 ELMWOOD AVENUE
ROCHESTER NY
14620
US

IV. Provider business mailing address

1018 PARK AVENUE
ROCHESTER NY
14610
US

V. Phone/Fax

Practice location:
  • Phone: 585-241-1200
  • Fax:
Mailing address:
  • Phone: 315-560-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number031305
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: