Provider Demographics
NPI:1477914323
Name:HEINZ, NAOMI ELISE (OTR/L)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:ELISE
Last Name:HEINZ
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 1:1127 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304
Mailing Address - Country:US
Mailing Address - Phone:708-822-2484
Mailing Address - Fax:
Practice Address - Street 1:820 NORTH BOULEVARD
Practice Address - Street 2:KIDS UNLIMITED THERAPY SERVICES, LLC
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301
Practice Address - Country:US
Practice Address - Phone:708-524-2445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056011266225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist