Provider Demographics
NPI:1669661955
Name:OTERO, HEATHER ANN (SLP)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ANN
Last Name:OTERO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 SW 120TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7440
Mailing Address - Country:US
Mailing Address - Phone:305-324-5363
Mailing Address - Fax:305-258-5904
Practice Address - Street 1:13400 SW 120TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7440
Practice Address - Country:US
Practice Address - Phone:305-324-5363
Practice Address - Fax:305-258-5904
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL892522400Medicaid