Provider Demographics
NPI:1306311907
Name:KAPTEYN, HEATHER (MT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:KAPTEYN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26669 SPICER ST
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3853
Mailing Address - Country:US
Mailing Address - Phone:248-495-0326
Mailing Address - Fax:
Practice Address - Street 1:26669 SPICER ST
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3853
Practice Address - Country:US
Practice Address - Phone:248-495-0326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM596675225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist