Healthcare Provider Details

I. General information

NPI: 1407266307
Provider Name (Legal Business Name): JUDY HEITMANN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 DOUGLAS AVE
URBANDALE IA
50322-2450
US

IV. Provider business mailing address

205 W WACKER DR SUITE 1020
CHICAGO IL
60606-1216
US

V. Phone/Fax

Practice location:
  • Phone: 515-251-3700
  • Fax: 515-251-3733
Mailing address:
  • Phone: 312-640-0329
  • Fax: 312-640-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number00356
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: