Healthcare Provider Details

I. General information

NPI: 1245666890
Provider Name (Legal Business Name): MRS. BRITTANEY DANIALLE HEFFKEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2013
Last Update Date: 09/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 OLD FAIRWAY RD
HUNTSVILLE AL
35806-6456
US

IV. Provider business mailing address

1020 OLD FAIRWAY RD
HUNTSVILLE AL
35806-6456
US

V. Phone/Fax

Practice location:
  • Phone: 256-690-3927
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3478
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: