Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 1709 | NE |
NPI | 1780073403 |
---|---|
Provider Name | Jan L. Herron |
First Address | Omaha, NE 68114-2675 |
Second Address | Omaha, NE 68102-1125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2015 |
Last Update Date | 19/01/2015 |