Individual
HEATHER MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
602 VONDERBURG DR, SUITE 201, BRANDON, FL 33511-5900
(813) 653-1149
(813) 654-6644
Mailing address
602 VONDERBURG DR, SUITE 201, BRANDON, FL 33511-5900
(813) 653-1149
(813) 654-6644
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
SA13141
FL
235Z00000X
Speech-Language Pathologist
Primary
SA13141
FL
235Z00000X
Speech-Language Pathologist
SZ6222
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012291400
—
FL
05
—
016117100
—
FL
Enumeration date
06/30/2014
Last updated
12/27/2016
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