Healthcare Provider Details

I. General information

NPI: 1780073403
Provider Name (Legal Business Name): JAN L. HERRON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2015
Last Update Date: 01/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 DODGE ST SUITE #6
OMAHA NE
68102-1125
US

IV. Provider business mailing address

770 N 93RD ST APT 2B8
OMAHA NE
68114-2675
US

V. Phone/Fax

Practice location:
  • Phone: 402-995-9874
  • Fax:
Mailing address:
  • Phone: 303-910-1847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number1709
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: