Provider Demographics
NPI:1174370480
Name:HEFFNER, JORDAN ADAIR (COTA/L)
Entity type:Individual
Prefix:MS
First Name:JORDAN
Middle Name:ADAIR
Last Name:HEFFNER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:JORDAN
Other - Middle Name:ADAIR
Other - Last Name:FOREMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3534 CEDARBROOK CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17222-9274
Mailing Address - Country:US
Mailing Address - Phone:954-554-9558
Mailing Address - Fax:
Practice Address - Street 1:201 FRANKLIN FARM LN
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17202-3060
Practice Address - Country:US
Practice Address - Phone:717-264-2715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP010508224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant