Provider Demographics
NPI:1902501612
Name:KINCAID, HEATHER NICOLE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:NICOLE
Last Name:KINCAID
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:NICOLE
Other - Last Name:PAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:524 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SAXTON
Mailing Address - State:PA
Mailing Address - Zip Code:16678-1034
Mailing Address - Country:US
Mailing Address - Phone:814-414-9044
Mailing Address - Fax:
Practice Address - Street 1:437 GIVLER DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:PA
Practice Address - Zip Code:16662-1635
Practice Address - Country:US
Practice Address - Phone:814-793-3728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP010377224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant