MEDICARE: ALYSSA PIPKIN HEIMBACH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist		IL

General Provider Information

NPI Number	:	1346107356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA PIPKIN HEIMBACH

Provider Business Mailing Address
First Line	:	2423 MAYFIELD DR
Second Line	:
City	:	MONTGOMERY
State	:	IL
Zip	:	60538-5057
Country	:	US
Telephone Number	:	630-450-0394
Fax Number	:

Provider Business Practice Location Address
First Line	:	2423 MAYFIELD DR
Second Line	:
City	:	MONTGOMERY
State	:	IL
Zip	:	60538-5057
Country	:	US
Telephone Number	:	630-450-0394
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/15/2026

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