Individual provider · NPI-1

Heather Brock, MA

Technician, Other · Lakeland, FL

NPI number1215469200
StatusActive
Last updated in NPPESMar 30, 2017

Details

NPI
1215469200
Entity type
Individual (NPI-1)
Name
Heather Brock
Credential
MA
Sex
Female
Sole proprietor
No
Enumeration date
Mar 30, 2017
Last updated
Mar 30, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
247200000X Technician, Other––Yes

Practice location

1835 Gilmore Ave
Lakeland, FL 33805-3017

Phone 863-519-0575

Mailing address

Po Box 1559
Bartow, FL 33831-1559

Phone 863-519-0575

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Other Technician, Other providers in Lakeland, FL