Provider Demographics
NPI:1992066542
Name:WOLFERT, HEIDI MARIE (OTR)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:MARIE
Last Name:WOLFERT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 SHENANDOAH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-4016
Mailing Address - Country:US
Mailing Address - Phone:618-201-1112
Mailing Address - Fax:
Practice Address - Street 1:3908 SHENANDOAH AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-4016
Practice Address - Country:US
Practice Address - Phone:618-201-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010016792225XP0019X
IL056006552225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation