Provider Demographics
NPI:1033436035
Name:HEIMKE, SUSAN E (OTR/L, CHT, CLT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:HEIMKE
Suffix:
Gender:F
Credentials:OTR/L, CHT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 METCALF AVENUE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202
Mailing Address - Country:US
Mailing Address - Phone:913-831-2721
Mailing Address - Fax:913-384-0127
Practice Address - Street 1:6405 METCALF AVENUE
Practice Address - Street 2:SUITE 220
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202
Practice Address - Country:US
Practice Address - Phone:913-831-2721
Practice Address - Fax:913-384-0127
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01011225XH1200X
MO2005035147225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17-01011OtherKANSAS STATE BOARD OF HEALING ARTS