Provider Demographics
NPI:1083948319
Name:WHITROCK, HEIDI LISA (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:LISA
Last Name:WHITROCK
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 1:1111 DEVONSHIRE EAST DR
Mailing Address - Street 2:#J
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-6959
Mailing Address - Country:US
Mailing Address - Phone:618-623-9221
Mailing Address - Fax:
Practice Address - Street 1:1111 DEVONSHIRE EAST DR
Practice Address - Street 2:# J
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-6959
Practice Address - Country:US
Practice Address - Phone:618-623-9221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001696A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant