Healthcare Provider Details

I. General information

NPI: 1568309250
Provider Name (Legal Business Name): HEATHER HEINRITZ OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 SELBY AVE
ST PAUL PARK MN
55071-1265
US

IV. Provider business mailing address

15201 TYACKE DR
BURNSVILLE MN
55306-5041
US

V. Phone/Fax

Practice location:
  • Phone: 651-425-3600
  • Fax:
Mailing address:
  • Phone: 651-747-5857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number101909
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: