Provider Demographics
NPI:1053546853
Name:AUSTIN, HEATHER RENEE (OT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:RENEE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 A AND W LN
Mailing Address - Street 2:
Mailing Address - City:TIOGA
Mailing Address - State:PA
Mailing Address - Zip Code:16946-8415
Mailing Address - Country:US
Mailing Address - Phone:570-835-4079
Mailing Address - Fax:
Practice Address - Street 1:150 A AND W LN
Practice Address - Street 2:
Practice Address - City:TIOGA
Practice Address - State:PA
Practice Address - Zip Code:16946-8415
Practice Address - Country:US
Practice Address - Phone:607-426-4983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008512-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist