Provider Demographics
NPI:1881904712
Name:HEIDBREDER, HEATHER L (OTR/L)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:HEIDBREDER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:733 KATHY LN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-9360
Mailing Address - Country:US
Mailing Address - Phone:573-645-8864
Mailing Address - Fax:
Practice Address - Street 1:733 KATHY LN
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-9360
Practice Address - Country:US
Practice Address - Phone:573-645-8864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009016791225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist