Basic Information
| Provider Information | |||||||||
| NPI: | 1891972840 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERRO | ||||||||
| FirstName: | MARLEEN | ||||||||
| MiddleName: | GRACE | ||||||||
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| Credential: | OTR/L,CHT,CLT-LANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4918 PAYSON WAY SE | ||||||||
| Address2: | |||||||||
| City: | SMYRNA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300807379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806959493 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1810 WHITE CIR | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300665835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704269945 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2008 | ||||||||
| LastUpdateDate: | 03/08/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | 0798 | AZ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 225XH1200X | OT005370 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
No ID Information.