MEDICARE: MRS. JOYCE HEIMER OTR/L, CLT

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	100369	MN

General Provider Information

NPI Number	:	1467836171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOYCE HEIMER OTR/L, CLT

Provider Business Mailing Address
First Line	:	5150 417TH ST
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-5261
Country	:	US
Telephone Number	:	651-674-8766
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 417TH ST
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-5261
Country	:	US
Telephone Number	:	651-674-8766
Fax Number	:

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

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	07/13/2015

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