Provider Demographics
NPI:1578379236
Name:HERMANSEN, HEATHER MAE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MAE
Last Name:HERMANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 BUCKINGHAM DR NW APT 6
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405-1138
Mailing Address - Country:US
Mailing Address - Phone:319-269-0634
Mailing Address - Fax:
Practice Address - Street 1:2332 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2771
Practice Address - Country:US
Practice Address - Phone:319-545-7390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000864225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist