| Doctor Name: | DR. HEATHER OTTMERS CADDELL |
| NPI Number: | 1154642551 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | |
| Business Practice Address: | 124 E Bandera Rd Suite 204 Boerne, TX - 780062849 |
| Business Phone Number: | 2106535501 |
| Business Fax Number: | 2106505975 |
| Mailing Address: | 1355 Central Pkwy S, Suite 400 SAN ANTONIO |
| State: | TX |
| Postal Code: | 782325055 |
| Phone Number: | 2105906195 |
| Fax Number: | 2106505993 |
| NPI Enumeration Date: | 06/20/2010 |
| NPI Last Update Date: | 07/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |