Individual
HEIDI LAINE FACKLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
218 W MCCABE ST, STRAFFORD, MO 65757-8840
(417) 736-7000
Mailing address
702 S EASTRIDGE, NIXA, MO 65714-7805
(417) 350-8760
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2024009426
MO
Other
Enumeration date
08/12/2025
Last updated
08/12/2025
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