Provider Demographics
NPI:1982199931
Name:HEINLE, CASEY HART
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:HART
Last Name:HEINLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 RESERVE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-1392
Mailing Address - Country:US
Mailing Address - Phone:866-564-3589
Mailing Address - Fax:866-350-6502
Practice Address - Street 1:215 N LAMAR AVE
Practice Address - Street 2:
Practice Address - City:HAYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:67060-1266
Practice Address - Country:US
Practice Address - Phone:316-524-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist