MEDICARE: BEVERLY JEAN HEIMBACH OTR/L

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	OC000562L	PA

General Provider Information

NPI Number	:	1609004654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY JEAN HEIMBACH OTR/L

Provider Business Mailing Address
First Line	:	2206 OAKWYN RD
Second Line	:
City	:	LAFAYETTE HILL
State	:	PA
Zip	:	19444-2232
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2206 OAKWYN RD
Second Line	:
City	:	LAFAYETTE HILL
State	:	PA
Zip	:	19444-2232
Country	:	US
Telephone Number	:	610-239-7100
Fax Number	:

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

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	06/29/2009

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