Provider Demographics
NPI:1598739781
Name:VANOPDORP, HEATHER LYNNE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LYNNE
Last Name:VANOPDORP
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 ASHLEY LAKES DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-1740
Mailing Address - Country:US
Mailing Address - Phone:813-391-7412
Mailing Address - Fax:
Practice Address - Street 1:401 W KENNEDY BLVD
Practice Address - Street 2:BOX I
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1450
Practice Address - Country:US
Practice Address - Phone:813-253-6264
Practice Address - Fax:813-253-6288
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 16332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer