Provider Demographics
NPI:1114146222
Name:DIBIASO, HEATHER ANN (OTR)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ANN
Last Name:DIBIASO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 FERNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR LOCKS
Mailing Address - State:CT
Mailing Address - Zip Code:06096-1408
Mailing Address - Country:US
Mailing Address - Phone:860-614-1487
Mailing Address - Fax:
Practice Address - Street 1:1715 ELLINGTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2707
Practice Address - Country:US
Practice Address - Phone:860-644-4408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002612225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist