Provider Demographics
NPI:1609518521
Name:HEATH, CHRISTINE WYATT (OTR)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:WYATT
Last Name:HEATH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:RENEE
Other - Last Name:WYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:13707 W VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2327
Mailing Address - Country:US
Mailing Address - Phone:303-989-1169
Mailing Address - Fax:
Practice Address - Street 1:13707 W VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2327
Practice Address - Country:US
Practice Address - Phone:303-989-1169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO348719225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist