Provider Demographics
NPI:1417424557
Name:VAN HEEST, KATY NICOLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:NICOLE
Last Name:VAN HEEST
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:NICOLE
Other - Last Name:LINDSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1101 MAIN ST NE UNIT 501
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1490
Mailing Address - Country:US
Mailing Address - Phone:952-210-4287
Mailing Address - Fax:
Practice Address - Street 1:500 HARVARD ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0363
Practice Address - Country:US
Practice Address - Phone:612-273-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105281225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist