Provider Demographics
NPI:1851569347
Name:WILLIAMS, HEIDI MARIE I
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:MARIE
Other - Last Name:CUKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19580 SCOUT LN
Mailing Address - Street 2:
Mailing Address - City:SAINT ONGE
Mailing Address - State:SD
Mailing Address - Zip Code:57779-7913
Mailing Address - Country:US
Mailing Address - Phone:605-491-2832
Mailing Address - Fax:
Practice Address - Street 1:540 FALCON CREST DR
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-3252
Practice Address - Country:US
Practice Address - Phone:605-642-2977
Practice Address - Fax:605-644-7490
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD186A224Z00000X
NE792224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant