Healthcare Provider Details

I. General information

NPI: 1891203030
Provider Name (Legal Business Name): HEATHER NOONAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 GRAND AVE UNIT 5
GLENWOOD SPRINGS CO
81601-3642
US

IV. Provider business mailing address

PO BOX 126
CHAMA NM
87520-0126
US

V. Phone/Fax

Practice location:
  • Phone: 970-665-4744
  • Fax: 970-549-2874
Mailing address:
  • Phone: 720-434-5797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA.0001558
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: