Healthcare Provider Details

I. General information

NPI: 1952510612
Provider Name (Legal Business Name): HEATHER LEE SIMPSON CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 EPWORTH HWY
PALMER LAKE CO
80133
US

IV. Provider business mailing address

PO BOX 1503
PALMER LAKE CO
80133
US

V. Phone/Fax

Practice location:
  • Phone: 719-660-3055
  • Fax: 719-559-1345
Mailing address:
  • Phone: 719-559-1345
  • Fax: 719-559-1345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: