MEDICARE: HEATHER L HEIDBREDER 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	2009016791	MO

General Provider Information

NPI Number	:	1881904712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER L HEIDBREDER OTR/L

Provider Business Mailing Address
First Line	:	733 KATHY LN
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-9360
Country	:	US
Telephone Number	:	573-645-8864
Fax Number	:

Provider Business Practice Location Address
First Line	:	733 KATHY LN
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-9360
Country	:	US
Telephone Number	:	573-645-8864
Fax Number	:

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

Provider Enumeration Date	:	10/13/2010
Last Update Date	:	02/23/2012

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