MEDICARE: HEARTLAND LACTATION LLC

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

General Provider Information

NPI Number	:	1891514659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND LACTATION LLC

Provider Business Mailing Address
First Line	:	520 LAUREL ST
Second Line	:
City	:	MINNEAPOLIS
State	:	KS
Zip	:	67467-3000
Country	:	US
Telephone Number	:	785-392-0217
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 W 2ND ST STE 1
Second Line	:
City	:	MINNEAPOLIS
State	:	KS
Zip	:	67467-2311
Country	:	US
Telephone Number	:	785-392-0217
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JACEE RIETBROCK
Credential	:
Telephone Number	:	785-392-0217

Provider Enumeration Date	:	10/08/2024
Last Update Date	:	10/08/2024

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Directions to “HEARTLAND LACTATION LLC ” Practice Location

Language	Start Address	Practice Location

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