Provider Demographics
NPI:1083007272
Name:HEPNER, ELLEN
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:HEPNER
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:PO BOX 50515
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-0304
Mailing Address - Country:US
Mailing Address - Phone:941-544-7720
Mailing Address - Fax:941-527-0583
Practice Address - Street 1:7330 REGINA ROYALE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-4579
Practice Address - Country:US
Practice Address - Phone:941-544-7720
Practice Address - Fax:941-527-0583
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014508400Medicaid