Healthcare Provider Details

I. General information

NPI: 1912288838
Provider Name (Legal Business Name): RENEE M HEROLD MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 REDLAND CT STE 100
OWINGS MILLS MD
21117-3272
US

IV. Provider business mailing address

300 REDLAND CT STE 100
OWINGS MILLS MD
21117-3272
US

V. Phone/Fax

Practice location:
  • Phone: 410-653-3161
  • Fax:
Mailing address:
  • Phone: 410-653-3161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number05959
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: