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General NPI Number Information
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NPI Number | 1275177529
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Entity Type | Individual
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Provider Name | KRISTEN ELIZABETH HEACOX OTR/L, CLWT
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Gender | Female
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Dates
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Enumeration Date | 10/30/2019
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Last Update Date | 10/30/2019
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Provider Practice Location Address
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Address Line | 24326 E MAXWELL AVE
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-8633
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Country | US
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Telephone | 509-218-3443
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Fax |
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Provider Business Mailing Address
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Address Line | 24326 E MAXWELL AVE
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-8633
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Country | US
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Telephone | 509-218-3443
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | OT60805745
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT60805745
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License Number State | WA
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