Provider Demographics
NPI:1437639531
Name:BEARDEN, HEATHER (COTA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BEARDEN
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 1:4269 SMOTHERS RD
Mailing Address - Street 2:
Mailing Address - City:MALAKOFF
Mailing Address - State:TX
Mailing Address - Zip Code:75148-4366
Mailing Address - Country:US
Mailing Address - Phone:903-288-5702
Mailing Address - Fax:
Practice Address - Street 1:1351 S ELM ST
Practice Address - Street 2:
Practice Address - City:KEMP
Practice Address - State:TX
Practice Address - Zip Code:75143-7713
Practice Address - Country:US
Practice Address - Phone:903-498-8073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214344224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant