Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1029 | CO |
NPI | 1063789469 |
---|---|
Provider Name | Heidi Lynne Stewart |
First Address | Highlands Ranch, CO 80163-1374 |
Second Address | Highlands Ranch, CO 80129-1709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2011 |
Last Update Date | 31/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
99106515 | (05) | CO |