Provider Demographics
NPI:1447555248
Name:HELLER, KEVIN MICHAEL (MS, OTR/L)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:HELLER
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DAKOTA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1107
Mailing Address - Country:US
Mailing Address - Phone:516-729-4301
Mailing Address - Fax:
Practice Address - Street 1:5 DAKOTA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1107
Practice Address - Country:US
Practice Address - Phone:516-729-4301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2013-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017028225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist