Provider Demographics
NPI:1932328689
Name:HENRICKS, HEIDI J
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:J
Last Name:HENRICKS
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 1:1714 GREYSTONE BLVD APT 49
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7558
Mailing Address - Country:US
Mailing Address - Phone:608-792-6020
Mailing Address - Fax:843-884-0565
Practice Address - Street 1:601 MATHIS FERRY RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-2623
Practice Address - Country:US
Practice Address - Phone:843-884-0212
Practice Address - Fax:843-884-0565
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3248225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist