Provider Demographics
NPI:1447475264
Name:HEIDEMANN, LAURA DAWN (MA, OTRL)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:DAWN
Last Name:HEIDEMANN
Suffix:
Gender:F
Credentials:MA, OTRL
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:DAWN
Other - Last Name:LINDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTS
Mailing Address - Street 1:101 BAVARIAN CIR
Mailing Address - Street 2:
Mailing Address - City:CANNON FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:55009-1201
Mailing Address - Country:US
Mailing Address - Phone:612-418-5284
Mailing Address - Fax:
Practice Address - Street 1:14301 EWING AVE S
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-5515
Practice Address - Country:US
Practice Address - Phone:952-746-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103371225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN79G74HEOtherRENDERING THERAPIST
MN103371OtherMDH OT LICENSE
MN220116OtherNBCOT CERTIFICATION