Healthcare Provider Details

I. General information

NPI: 1104264951
Provider Name (Legal Business Name): VERONICA HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E WOOD ST
CLEARWATER KS
67026-9757
US

IV. Provider business mailing address

1201 CONARD AVE
GARDEN CITY KS
67846-3917
US

V. Phone/Fax

Practice location:
  • Phone: 620-338-6665
  • Fax:
Mailing address:
  • Phone: 620-338-6665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1800409
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: