MEDICARE: HEATHER NOONAN

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	106S00000X	Behavior Technician
2	224Z00000X	Occupational Therapy Assistant	OTA.0001558	CO

General Provider Information

NPI Number	:	1891203030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER NOONAN

Provider Business Mailing Address
First Line	:	PO BOX 126
Second Line	:
City	:	CHAMA
State	:	NM
Zip	:	87520-0126
Country	:	US
Telephone Number	:	720-434-5797
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 GRAND AVE UNIT 5
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-3642
Country	:	US
Telephone Number	:	970-665-4744
Fax Number	:	970-549-2874

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

Provider Enumeration Date	:	01/22/2018
Last Update Date	:	04/18/2022

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Directions to “ HEATHER NOONAN ” Practice Location

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