Provider Demographics
NPI:1720823552
Name:HEETDERKS, ANNIKA
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:
Last Name:HEETDERKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 SW 37TH AVE APT 507
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1768
Mailing Address - Country:US
Mailing Address - Phone:786-246-1446
Mailing Address - Fax:
Practice Address - Street 1:4960 SW 72ND AVE STE 210
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5549
Practice Address - Country:US
Practice Address - Phone:305-461-4702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25225225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist