Provider Demographics
NPI:1841781366
Name:SPYRIDAKIS, HEIDI (MOT,OTRL)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:SPYRIDAKIS
Suffix:
Gender:F
Credentials:MOT,OTRL
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:RONCHETTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT,OTRL
Mailing Address - Street 1:56108 KEN CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-5547
Mailing Address - Country:US
Mailing Address - Phone:586-596-2348
Mailing Address - Fax:
Practice Address - Street 1:15595 15 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-2185
Practice Address - Country:US
Practice Address - Phone:586-285-3884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005558225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist