Basic Information
| Provider Information | |||||||||
| NPI: | 1033676507 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | NOLTING | ||||||||
| FirstName: | HEATHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15029 RIDGE LAKE DR | ||||||||
| Address2: | |||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630177638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146104101 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5400 EXECUTIVE CENTRE PKWY | ||||||||
| Address2: | |||||||||
| City: | SAINT PETERS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633762594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369227600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2019 | ||||||||
| LastUpdateDate: | 02/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 005220 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.