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NPI Code Detail

MEDICARE: JOSEPHINE SOPHIE HEINZ OTD, OTR/L

MEDICARE: JOSEPHINE SOPHIE HEINZ OTD, OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist456359CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1100363842OTHERWYCIGNA

General Provider Information

NPI Number : 1982378576
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPHINE SOPHIE HEINZ OTD, OTR/L
Provider Business Mailing Address
First Line : 1054 BANOCK DR
Second Line :
City : LARAMIE
State : WY
Zip : 82072-6905
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1660 ALLISON ST
Second Line :
City : LAKEWOOD
State : CO
Zip : 80214-6023
Country : US
Telephone Number : 303-232-0883
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2021
Last Update Date : 08/06/2021

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