Provider Demographics
NPI:1053296962
Name:CONLEY, HEATHER D (LPAT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
Last Name:CONLEY
Suffix:
Gender:F
Credentials:LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 POPLAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:KY
Mailing Address - Zip Code:41001-7331
Mailing Address - Country:US
Mailing Address - Phone:859-628-0089
Mailing Address - Fax:
Practice Address - Street 1:1265 POPLAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:KY
Practice Address - Zip Code:41001-7331
Practice Address - Country:US
Practice Address - Phone:859-628-0089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY291612221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist