Provider Demographics
NPI:1962567842
Name:RIZK, HEATHER MARIE (OTRL)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MARIE
Last Name:RIZK
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 S MENDON RD
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:VT
Mailing Address - Zip Code:05701-9643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:INTERSECTIONS OF RTS 4 AND 12
Practice Address - Street 2:
Practice Address - City:TAFTSVILLE
Practice Address - State:VT
Practice Address - Zip Code:05073
Practice Address - Country:US
Practice Address - Phone:802-457-4487
Practice Address - Fax:802-457-9428
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0720000386225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00059215OtherBCBS OF VERMONT