Provider Demographics
NPI:1265793350
Name:HEILIGENSTEIN, KARA LYNN
Entity type:Individual
Prefix:MS
First Name:KARA
Middle Name:LYNN
Last Name:HEILIGENSTEIN
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 1:2691 GLENDRIVE PL
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-1644
Mailing Address - Country:US
Mailing Address - Phone:314-440-6869
Mailing Address - Fax:
Practice Address - Street 1:2691 GLENDRIVE PL
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-1644
Practice Address - Country:US
Practice Address - Phone:314-440-6869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000143570224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant