Provider Demographics
NPI:1710327465
Name:MARY, HEIDI M (OTR)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:M
Last Name:MARY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PRAIRIE HAWK DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-8001
Mailing Address - Country:US
Mailing Address - Phone:720-433-1258
Mailing Address - Fax:
Practice Address - Street 1:701 PRAIRIE HAWK DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8001
Practice Address - Country:US
Practice Address - Phone:720-433-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist