Provider Demographics
NPI:1053457903
Name:HEINZE, LINDA K (OTRL, CHT)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:K
Last Name:HEINZE
Suffix:
Gender:F
Credentials:OTRL, CHT
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:K
Other - Last Name:PAWELEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13537 BARRETT PARKWAY DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5899
Mailing Address - Country:US
Mailing Address - Phone:314-821-9126
Mailing Address - Fax:314-821-9142
Practice Address - Street 1:790 N US HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-5108
Practice Address - Country:US
Practice Address - Phone:314-972-1442
Practice Address - Fax:314-972-1533
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003983225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO222971509Medicare PIN
MO222971511Medicare PIN