Healthcare Provider Details

I. General information

NPI: 1326558248
Provider Name (Legal Business Name): BRITTANY LYNN HERRADA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 HARTFORD ST
ABILENE TX
79605-4603
US

IV. Provider business mailing address

4601 HARTFORD ST
ABILENE TX
79605-4603
US

V. Phone/Fax

Practice location:
  • Phone: 325-793-3400
  • Fax:
Mailing address:
  • Phone: 325-793-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number118692
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: