Provider Demographics
NPI:1033340344
Name:SUNDAY, HEIDI GORMAN (COTA)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:GORMAN
Last Name:SUNDAY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 752
Mailing Address - Street 2:
Mailing Address - City:WASHBURN
Mailing Address - State:WI
Mailing Address - Zip Code:54891-0752
Mailing Address - Country:US
Mailing Address - Phone:715-373-5807
Mailing Address - Fax:
Practice Address - Street 1:911 3RD ST W
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1311
Practice Address - Country:US
Practice Address - Phone:715-682-8172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4708-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant