Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT.0004164 | CO |
NPI | 1003211939 |
---|---|
Provider Name | Heather Noelle Vaughn |
First Address | Longmont, CO 80503-7126 |
Second Address | Longmont, CO 80503-7126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2014 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
48731765 | (05) | CO |