Provider Demographics
NPI:1093407108
Name:THOMPSON, HEATHER DAWN (COTA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:THOMPSON
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 1:108 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2824
Mailing Address - Country:US
Mailing Address - Phone:304-253-2273
Mailing Address - Fax:304-256-6359
Practice Address - Street 1:108 SUNSET DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2824
Practice Address - Country:US
Practice Address - Phone:304-253-2273
Practice Address - Fax:304-256-6359
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC1440224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant