Provider Demographics
NPI:1235188327
Name:HELDENMUTH, TRACEY B (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:B
Last Name:HELDENMUTH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 NE 124 ST
Mailing Address - Street 2:
Mailing Address - City:N. MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2617
Mailing Address - Country:US
Mailing Address - Phone:305-343-5656
Mailing Address - Fax:305-895-0887
Practice Address - Street 1:2090 NE 124 ST
Practice Address - Street 2:
Practice Address - City:N. MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2617
Practice Address - Country:US
Practice Address - Phone:305-343-5656
Practice Address - Fax:305-895-0887
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT #0001763225X00000X
FL1763225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY902JOtherBLUECROSS BLUE SHIELD
FL8881757000Medicaid