Provider Demographics
NPI:1003082249
Name:BANKS, HEATHER SUTTON (COTA/L)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:SUTTON
Last Name:BANKS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAMPTON WOODS COMPLEX
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NC
Mailing Address - Zip Code:27845-9503
Mailing Address - Country:US
Mailing Address - Phone:252-534-4521
Mailing Address - Fax:252-534-4521
Practice Address - Street 1:200 HAMPTON WOODS COMPLEX
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NC
Practice Address - Zip Code:27845-9503
Practice Address - Country:US
Practice Address - Phone:252-534-4521
Practice Address - Fax:252-534-4521
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3344224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant