Healthcare Provider Details

I. General information

NPI: 1457865545
Provider Name (Legal Business Name): CELINE COTY HEFLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5496 COCONUT BLVD
WEST PALM BEACH FL
33411-8542
US

IV. Provider business mailing address

4297 EVELYN PL LOT 207
LAKE WORTH FL
33463-4515
US

V. Phone/Fax

Practice location:
  • Phone: 561-305-7268
  • Fax:
Mailing address:
  • Phone: 561-360-0913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: