Provider Demographics
NPI:1811160849
Name:HEIDENREICH, CYNTHIA ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:HEIDENREICH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12115 S WOLF DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-9755
Mailing Address - Country:US
Mailing Address - Phone:815-685-4608
Mailing Address - Fax:815-439-5955
Practice Address - Street 1:12115 S WOLF DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-9755
Practice Address - Country:US
Practice Address - Phone:815-685-4608
Practice Address - Fax:815-439-5955
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics