Healthcare Provider Details

I. General information

NPI: 1073681011
Provider Name (Legal Business Name): KIMBERLY HERRING-ANTHONY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9302 N MERIDIAN ST SUITE 355
INDIANAPOLIS IN
46260-1873
US

IV. Provider business mailing address

9302 N MERIDIAN ST SUITE 355
INDIANAPOLIS IN
46260-1873
US

V. Phone/Fax

Practice location:
  • Phone: 317-571-9595
  • Fax: 317-571-9696
Mailing address:
  • Phone: 317-571-9595
  • Fax: 317-571-9696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number31002231A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: