Provider Demographics
NPI:1174353296
Name:KIDWELL, HEIDI JANE (COTA/L)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:JANE
Last Name:KIDWELL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 SW 89TH ST APT 1008
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9454
Mailing Address - Country:US
Mailing Address - Phone:405-921-6358
Mailing Address - Fax:
Practice Address - Street 1:401 S COLTRANE RD STE 260
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6722
Practice Address - Country:US
Practice Address - Phone:405-921-6358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2512224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant