Provider Demographics
NPI:1992971766
Name:HEATER, AMY ILENE (COTA)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ILENE
Last Name:HEATER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 FORBES AVE
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-8703
Mailing Address - Country:US
Mailing Address - Phone:765-469-2736
Mailing Address - Fax:
Practice Address - Street 1:1507 FORBES AVE
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-8703
Practice Address - Country:US
Practice Address - Phone:765-469-2736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001282A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant