Healthcare Provider Details

I. General information

NPI: 1134200678
Provider Name (Legal Business Name): HEIDI MARIAN SCHRECK HS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMDT CG-1122 US COAST GUARD 2100 2ND ST. SW, SUITE 5314
WASHINGTON DC
20593-0001
US

IV. Provider business mailing address

1405 TEMPLE ST
CLEARWATER FL
33756-2354
US

V. Phone/Fax

Practice location:
  • Phone: 727-535-1437
  • Fax: 727-535-4190
Mailing address:
  • Phone: 206-250-7113
  • Fax: 727-535-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: