Active NPI
Heather Conklin, COTA
- Occupational Therapy Assistant
- Fuquay Varina, NC
National Provider Identifier
1992942304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 6722
- Practice address
- 7237 Blue Juniper CT
Fuquay Varina, NC 27526-5469 - Phone
- (845) 742-4814
- NPI assigned
- Jan 7, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 6722 | NC | Primary |
Addresses
Primary practice location
7237 Blue Juniper CT
Fuquay Varina, NC 27526-5469
Mailing address
7237 Blue Juniper CT
Fuquay Varina, NC 27526-5469
Phone (845) 742-4814
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6722 | NC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231286400000",
"number": "1992942304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7237 BLUE JUNIPER CT",
"city": "FUQUAY VARINA",
"state": "NC",
"postal_code": "275265469",
"telephone_number": "845-742-4814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7237 BLUE JUNIPER CT",
"city": "FUQUAY VARINA",
"state": "NC",
"postal_code": "275265469",
"telephone_number": "845-742-4814"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONKLIN",
"first_name": "HEATHER",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-07",
"last_updated": "2009-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NC",
"license": "6722",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fuquay Varina, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.