Individual
MRS. LAURA DAWN HEIDEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, OTRL
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
103371
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103371
MDH OT LICENSE
MN
01
—
220116
NBCOT CERTIFICATION
MN
01
—
79G74HE
RENDERING THERAPIST
MN
Enumeration date
04/16/2007
Last updated
07/08/2007
Update your record
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