Basic Information
| Provider Information | |||||||||
| NPI: | 1982199931 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEINLE | ||||||||
| FirstName: | CASEY | ||||||||
| MiddleName: | HART | ||||||||
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| Mailing Information | |||||||||
| Address1: | 990 RESERVE DR STE 250 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956781392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8665643589 | ||||||||
| FaxNumber: | 8663506502 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 N LAMAR AVE | ||||||||
| Address2: | |||||||||
| City: | HAYSVILLE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670601266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3165243211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2018 | ||||||||
| LastUpdateDate: | 06/22/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.