MEDICARE: KIM C HEISKELL OTR

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	17-01565	KS

General Provider Information

NPI Number	:	1396876504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM C HEISKELL OTR

Provider Business Mailing Address
First Line	:	13303 SW 210TH
Second Line	:
City	:	DOUGLASS
State	:	KS
Zip	:	67039
Country	:	US
Telephone Number	:	316-747-2859
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 E. WOOD
Second Line	:
City	:	CLEARWATER
State	:	KS
Zip	:	67026-9757
Country	:	US
Telephone Number	:	620-584-4542
Fax Number	:

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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Directions to “ KIM C HEISKELL OTR” Practice Location

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