Individual
KRISTIN JO HEESACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1702 HILLCREST DR, BELLEVUE, NE 68005-3652
(402) 555-5555
Mailing address
5057 S 84TH CT APT 10, OMAHA, NE 68127-2676
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1065
NE
Other
Enumeration date
06/18/2007
Last updated
07/08/2007
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