Provider Demographics
NPI:1447505102
Name:SYKES, HEATHER RAE (COTA)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:RAE
Last Name:SYKES
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 E ASHTON AVE
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-8945
Mailing Address - Country:US
Mailing Address - Phone:863-414-2159
Mailing Address - Fax:
Practice Address - Street 1:4001 HOME ST
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-2802
Practice Address - Country:US
Practice Address - Phone:877-221-9349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 10573314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility