MEDICARE: HEATHER NICCUM RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1083502777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER NICCUM RBT

Provider Business Mailing Address
First Line	:	816 W ENSLEY AVE
Second Line	:
City	:	AUBURN
State	:	IN
Zip	:	46706-2604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12938 COLDWATER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-9517
Country	:	US
Telephone Number	:	317-815-5501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2025
Last Update Date	:	12/19/2025

Similar Medicare Providers

1730042326 — ZAYNA STANKOVIC
Practice Location Address:

12938 COLDWATER RD
FORT WAYNE, IN
46845-9517

Practice Phone: 317-815-5501
Practice Fax:

1891120382 — SALKELD FAMILY DENTAL, LLC
Practice Location Address:

12962 COLDWATER RD
FORT WAYNE, IN
46845-9517

Practice Phone: 260-637-4648
Practice Fax:

1689033656 — TREVA E SMITH BCBA
Practice Location Address:

12938 COLDWATER RD
FORT WAYNE, IN
46845-9517

Practice Phone: 317-815-5501
Practice Fax:

1053921478 — KAYLA MOGG OTD, OTR/L
Practice Location Address:

12938 COLDWATER RD
FORT WAYNE, IN
46845-9517

Practice Phone: 260-245-1455
Practice Fax:

1861096265 — JESSICA MARIE PETERS M.H.S CCC-SLP
Practice Location Address:

12938 COLDWATER RD
FORT WAYNE, IN
46845-9517

Practice Phone: 260-245-1455
Practice Fax:

1639892540 — BERTSCH FAMILY DENTISTRY LLC
Practice Location Address:

12962 COLDWATER RD
FORT WAYNE, IN
46845-9517

Practice Phone: 260-637-4648
Practice Fax:

Directions to “ HEATHER NICCUM RBT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.