MEDICARE: VIVIAN HENKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist
2	252Y00000X	Early Intervention Provider Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881365260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN HENKE

Provider Business Mailing Address
First Line	:	3307 KATHLEEN DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-3714
Country	:	US
Telephone Number	:	828-335-6511
Fax Number	:

Provider Business Practice Location Address
First Line	:	3307 KATHLEEN DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-3714
Country	:	US
Telephone Number	:	828-335-6511
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2021
Last Update Date	:	09/24/2021

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Directions to “ VIVIAN HENKE ” Practice Location

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