Provider Demographics
NPI:1255648622
Name:HEIER, BRIDGET A (COTA/L)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:A
Last Name:HEIER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:VIBORG
Mailing Address - State:SD
Mailing Address - Zip Code:57070-0368
Mailing Address - Country:US
Mailing Address - Phone:605-326-5161
Mailing Address - Fax:605-326-5734
Practice Address - Street 1:315 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:VIBORG
Practice Address - State:SD
Practice Address - Zip Code:57070-0368
Practice Address - Country:US
Practice Address - Phone:605-326-5161
Practice Address - Fax:605-326-5734
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD243A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant