Provider Demographics
NPI:1437821725
Name:FENNEL, HEIDI JENSEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:JENSEN
Last Name:FENNEL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47755 324TH ST
Mailing Address - Street 2:
Mailing Address - City:ELK POINT
Mailing Address - State:SD
Mailing Address - Zip Code:57025-6741
Mailing Address - Country:US
Mailing Address - Phone:605-659-4932
Mailing Address - Fax:
Practice Address - Street 1:2710 W 12TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-3701
Practice Address - Country:US
Practice Address - Phone:605-328-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0972225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0972OtherSOUTH DAKOTA BOARD OF MEDICAL AND OSTEOPATHIC EXAMINERS