Heather Carroll, COTA

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Practice address

430 E Cleveland Rd
Granger, IN 46530-5624

Phone

(574) 271-3305

NPI assigned

Aug 21, 2014

Last updated

Aug 21, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Heather Warrell Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1408579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408579200000",
    "number": "1346649688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19839 DICE ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466145513",
            "telephone_number": "574-217-2213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 E CLEVELAND RD",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465305624",
            "telephone_number": "574-271-3305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "HEATHER",
        "credential": "COTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-21",
        "last_updated": "2014-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COTA",
            "identifier": "32001597A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "WARRELL",
            "credential": "COTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Assisted Living Facility (Mental Illness) in Granger, IN
• Providers in Granger, IN by specialty
• Assisted Living Facility (Mental Illness) in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.