Provider Demographics
NPI:1295579399
Name:HECKMAN, GRACE DOROTHY (OTR/L)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:DOROTHY
Last Name:HECKMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:DOROTHY
Other - Last Name:TOEBES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1807 STONEBRIDGE RD APT 101
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-5134
Mailing Address - Country:US
Mailing Address - Phone:262-355-6687
Mailing Address - Fax:
Practice Address - Street 1:N91W15750 FALLS PKWY
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2301
Practice Address - Country:US
Practice Address - Phone:262-532-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7266225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist