Provider Demographics
NPI:1043871981
Name:HEUSINKVELT, SARA MARIE
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:HEUSINKVELT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1479 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:DANNEBROG
Mailing Address - State:NE
Mailing Address - Zip Code:68831-3503
Mailing Address - Country:US
Mailing Address - Phone:308-750-2406
Mailing Address - Fax:
Practice Address - Street 1:1005 N 8TH ST
Practice Address - Street 2:
Practice Address - City:LOUP CITY
Practice Address - State:NE
Practice Address - Zip Code:68853-8215
Practice Address - Country:US
Practice Address - Phone:308-745-0352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant