Individual provider Active NPI

Heather Ann Petrusek, OTR

  • Occupational Therapist
  • Depew, NY
National Provider Identifier
1194009670
Registry record updated Feb 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Practice address
6221 Transit Rd
Depew, NY 14043-1024
Phone
(716) 866-6026
NPI assigned
Oct 3, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X NY Primary

Addresses

Primary practice location

6221 Transit Rd
Depew, NY 14043-1024

Mailing address

6 Joseph Dr
Lancaster, NY 14086-9439
Phone (716) 866-6026

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200310002619 NY Practitioner - Occupational Therapist in Private Practice 9739517590 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Monroe Ddso Clinic Pittsford CurrentSince May 4, 2023 Accepting new patients

Locations

44 Holland Ave
Fl 4
Albany, NY 12208

305 Main St
Binghamton, NY 13905
Phone (607) 729-1295

106 Pine St
Hamburg, NY 14075
Phone (716) 646-0048

1200 East and West Rd
Bldg 16
West Seneca, NY 14224
Phone (716) 517-2000

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580688000000",
    "number": "1194009670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 JOSEPH DR",
            "city": "LANCASTER",
            "state": "NY",
            "postal_code": "140869439",
            "telephone_number": "716-866-6026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6221 TRANSIT RD",
            "city": "DEPEW",
            "state": "NY",
            "postal_code": "140431024",
            "telephone_number": "716-866-6026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUSEK",
        "first_name": "HEATHER",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-03",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Depew, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.