Provider Demographics
NPI:1902683550
Name:MODZELEWSKI, HEATHER LEE
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:LEE
Last Name:MODZELEWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LEE
Other - Last Name:FREDDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 MAPLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:CT
Mailing Address - Zip Code:06071-1503
Mailing Address - Country:US
Mailing Address - Phone:860-929-9026
Mailing Address - Fax:
Practice Address - Street 1:36 MAPLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:CT
Practice Address - Zip Code:06071-1503
Practice Address - Country:US
Practice Address - Phone:860-929-9026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist