Provider Demographics
NPI:1588906408
Name:ENDER, HEATHER RAE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RAE
Last Name:ENDER
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 VIA CALLEJON
Mailing Address - Street 2:STE B
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6213
Mailing Address - Country:US
Mailing Address - Phone:949-498-5100
Mailing Address - Fax:949-366-5664
Practice Address - Street 1:1120 VIA CALLEJON
Practice Address - Street 2:STE B
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6213
Practice Address - Country:US
Practice Address - Phone:949-498-5100
Practice Address - Fax:949-366-5664
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist