Provider Demographics
NPI:1356815823
Name:GORMAN, HEATHER (COTA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GORMAN
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 1:864 BUNTING AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-1804
Mailing Address - Country:US
Mailing Address - Phone:719-574-2334
Mailing Address - Fax:
Practice Address - Street 1:864 BUNTING AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1804
Practice Address - Country:US
Practice Address - Phone:719-574-2334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001157224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant