MEDICARE: HEATHER NACOLE ACKART OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT-1415	WY
2	225X00000X	Occupational Therapist	OT.0005820	CO

General Provider Information

NPI Number	:	1700449071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER NACOLE ACKART OTR/L

Provider Business Mailing Address
First Line	:	1230 CASA GRANDE BLVD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-2555
Country	:	US
Telephone Number	:	970-402-3560
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 MCCLELLAND DR STE 3000J
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5206
Country	:	US
Telephone Number	:	970-493-6667
Fax Number	:	719-931-5559

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2019
Last Update Date	:	03/10/2021

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