Provider Demographics
NPI:1811156383
Name:HEIM, VALERIE DIANE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:DIANE
Last Name:HEIM
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 1:122 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PECATONICA
Mailing Address - State:IL
Mailing Address - Zip Code:61063-9205
Mailing Address - Country:US
Mailing Address - Phone:815-988-4438
Mailing Address - Fax:
Practice Address - Street 1:122 E 8TH ST
Practice Address - Street 2:
Practice Address - City:PECATONICA
Practice Address - State:IL
Practice Address - Zip Code:61063-9205
Practice Address - Country:US
Practice Address - Phone:815-988-4438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057001045224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL057001045OtherPROFESSIONAL LICENSE