Provider Demographics
NPI:1295999035
Name:COLLETT, HEATHER LENORE (OTRL)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LENORE
Last Name:COLLETT
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1689
Mailing Address - Street 2:
Mailing Address - City:HYDEN
Mailing Address - State:KY
Mailing Address - Zip Code:41749-1689
Mailing Address - Country:US
Mailing Address - Phone:606-374-3450
Mailing Address - Fax:
Practice Address - Street 1:93 BELLWOOD LN
Practice Address - Street 2:
Practice Address - City:BLEDSOE
Practice Address - State:KY
Practice Address - Zip Code:40810
Practice Address - Country:US
Practice Address - Phone:606-374-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2858225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist