Healthcare Provider Details

I. General information

NPI: 1972842508
Provider Name (Legal Business Name): HEATHER NICOLE SPRY OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39664 E 230TH ST
POLO MO
64671-8124
US

IV. Provider business mailing address

39664 E 230TH ST
POLO MO
64671-8124
US

V. Phone/Fax

Practice location:
  • Phone: 660-329-2896
  • Fax: 660-329-2896
Mailing address:
  • Phone:
  • Fax: 660-329-2896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2013002491
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: