Provider Demographics
NPI:1518234806
Name:BIGWOOD-CHAMPION, HEATHER MARIA (COTA/L)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIA
Last Name:BIGWOOD-CHAMPION
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 E D ST
Mailing Address - Street 2:APT A
Mailing Address - City:HILLSBORO
Mailing Address - State:KS
Mailing Address - Zip Code:67063-1844
Mailing Address - Country:US
Mailing Address - Phone:701-520-4596
Mailing Address - Fax:
Practice Address - Street 1:704 S ASH ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:KS
Practice Address - Zip Code:67063-1506
Practice Address - Country:US
Practice Address - Phone:620-947-2272
Practice Address - Fax:620-947-1465
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00761224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant