Healthcare Provider Details

I. General information

NPI: 1043871981
Provider Name (Legal Business Name): SARA MARIE HEUSINKVELT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N 8TH ST
LOUP CITY NE
68853-8215
US

IV. Provider business mailing address

1479 9TH AVE
DANNEBROG NE
68831-3503
US

V. Phone/Fax

Practice location:
  • Phone: 308-745-0352
  • Fax:
Mailing address:
  • Phone: 308-750-2406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: