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General NPI Number Information
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NPI Number | 1174743447
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Entity Type | Individual
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Provider Name | MARCIA HERRITAGE
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Gender | Female
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2250 HICKORY RD
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462-1047
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Country | US
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Telephone | 610-834-1122
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Fax |
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Provider Business Mailing Address
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Address Line | 28 E MOUNT VERNON PL APT #3
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City | BALTIMORE
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State | MD
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Zip | 21202
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Country | US
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Telephone | 443-752-2071
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | A01466
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License Number State | MD
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