Provider Demographics
NPI:1376196204
Name:WARNER, HEATHER NICOLE KAREN (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:NICOLE KAREN
Last Name:WARNER
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 E MOORHEAD CIR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6109
Mailing Address - Country:US
Mailing Address - Phone:919-523-0600
Mailing Address - Fax:
Practice Address - Street 1:1019 E MOORHEAD CIR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-6109
Practice Address - Country:US
Practice Address - Phone:919-523-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0006065225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics