Healthcare Provider Details

I. General information

NPI: 1558975243
Provider Name (Legal Business Name): HEATHER WOOTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date: 04/22/2026
Reactivation Date: 05/15/2026

III. Provider practice location address

1270 BELMONT AVE
SCHENECTADY NY
12308-2104
US

IV. Provider business mailing address

201 W SPRINGDALE AVE
KNOXVILLE TN
37917-5158
US

V. Phone/Fax

Practice location:
  • Phone: 518-382-4500
  • Fax:
Mailing address:
  • Phone: 865-637-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number030351
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: