Provider Demographics
NPI:1639377252
Name:MORNINGSTAR, HEATHER LYNN (MOT, OTRL)
Entity type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:LYNN
Last Name:MORNINGSTAR
Suffix:
Gender:F
Credentials:MOT, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:23928 125TH ST
Mailing Address - Street 2:
Mailing Address - City:TREVOR
Mailing Address - State:WI
Mailing Address - Zip Code:53179-9429
Mailing Address - Country:US
Mailing Address - Phone:847-323-8057
Mailing Address - Fax:224-788-8121
Practice Address - Street 1:311 W DEPOT ST
Practice Address - Street 2:SUITE F
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1500
Practice Address - Country:US
Practice Address - Phone:847-838-8085
Practice Address - Fax:224-788-8121
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-005853225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics