MEDICARE: KATHRYN HEGGBLOD

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1255743415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN HEGGBLOD

Provider Business Mailing Address
First Line	:	1452 N US HIGHWAY 1
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-6638
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1452 N US HIGHWAY 1
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-6638
Country	:	US
Telephone Number	:	386-672-1250
Fax Number	:

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

Provider Enumeration Date	:	05/22/2014
Last Update Date	:	05/22/2014

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Directions to “ KATHRYN HEGGBLOD ” Practice Location

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