Provider Demographics
NPI:1265629471
Name:HEUMILLER, AMY MARIE (OT/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:HEUMILLER
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44110 254TH ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:SD
Mailing Address - Zip Code:57058-5536
Mailing Address - Country:US
Mailing Address - Phone:605-421-1728
Mailing Address - Fax:605-425-2463
Practice Address - Street 1:511 S. NEBRASKA
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:SD
Practice Address - Zip Code:57058
Practice Address - Country:US
Practice Address - Phone:605-421-1728
Practice Address - Fax:605-425-2463
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0119225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist