Healthcare Provider Details

I. General information

NPI: 1376196204
Provider Name (Legal Business Name): HEATHER NICOLE KAREN ANDERSON OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23035 SCHUSSMARK TRL UNIT B
OAK CREEK CO
80467-9661
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 919-523-0600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1427986-4201
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT.0006065
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: