Provider Demographics
NPI:1104008895
Name:HETZNECKER, CHALENA R (CMF)
Entity type:Individual
Prefix:MS
First Name:CHALENA
Middle Name:R
Last Name:HETZNECKER
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 N SPRING GARDEN AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-0900
Mailing Address - Country:US
Mailing Address - Phone:877-337-7465
Mailing Address - Fax:877-793-4945
Practice Address - Street 1:929 N SPRING GARDEN AVE STE 120
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0900
Practice Address - Country:US
Practice Address - Phone:877-337-7465
Practice Address - Fax:877-793-4945
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000836756OOtherAMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS,PROSTHETICS & PEDORTHICS, INC