Provider Demographics
NPI:1851898308
Name:RECHENBERG, HEIDI (OTR/L)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:RECHENBERG
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 1:8617 KEMMAN RD
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:IL
Mailing Address - Zip Code:60034-9686
Mailing Address - Country:US
Mailing Address - Phone:573-208-6575
Mailing Address - Fax:
Practice Address - Street 1:3300 CHARLES MILLER RD APT 227
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-0714
Practice Address - Country:US
Practice Address - Phone:815-344-8408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.012432225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist