Provider Demographics
NPI:1164569349
Name:CROSS, HEATHER L (OTR)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:CROSS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 TAM O SHANTER WAY
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8854
Mailing Address - Country:US
Mailing Address - Phone:719-481-9453
Mailing Address - Fax:
Practice Address - Street 1:8540 SCARBOROUGH DRIVE
Practice Address - Street 2:SUITE 290
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-597-0822
Practice Address - Fax:719-599-4606
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
995469225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist