Healthcare Provider Details

I. General information

NPI: 1811247141
Provider Name (Legal Business Name): HEIDI DAWN HOSKINS MS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 MEMORIAL DRIVE, MOC 3 SUITE 150
BELLEVILLE IL
62226
US

IV. Provider business mailing address

4700 MEMORIAL DRIVE, MOC 3 SUITE 150
BELLEVILLE IL
62226
US

V. Phone/Fax

Practice location:
  • Phone: 618-257-5758
  • Fax: 618-257-5298
Mailing address:
  • Phone: 618-257-5758
  • Fax: 618-257-5298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number056.004829
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056.004829
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: