=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619854072
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEIDI WATKINS COTA/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2025
-----------------------------------------------------
Last Update Date | 08/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 142 JENKINS MEMORIAL RD
-----------------------------------------------------
City | WELLSTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45692-9561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-384-2119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 260 CRESTWOOD DR
-----------------------------------------------------
City | WAVERLY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45690-9658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | 004688
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------