Provider Demographics
NPI:1568666527
Name:BERTONCIN, HEIDI LYNN (OTR)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNN
Last Name:BERTONCIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5922 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2920
Mailing Address - Country:US
Mailing Address - Phone:913-262-7232
Mailing Address - Fax:
Practice Address - Street 1:8745 JAMES A REED RD
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-4414
Practice Address - Country:US
Practice Address - Phone:816-761-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003579225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist