Provider Demographics
NPI:1427801422
Name:MABIFA, HEIDA K (COTA/L)
Entity type:Individual
Prefix:
First Name:HEIDA
Middle Name:K
Last Name:MABIFA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:HEIDA
Other - Middle Name:K
Other - Last Name:VALDIMARSDOTTIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:744 GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1411
Mailing Address - Country:US
Mailing Address - Phone:386-222-5607
Mailing Address - Fax:
Practice Address - Street 1:303 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2709
Practice Address - Country:US
Practice Address - Phone:386-222-5607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
19824224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant