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NPI Code Detail

MEDICARE: MAYA HELEN HERZOG OTR/L

MEDICARE: MAYA HELEN HERZOG OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT60926626WA

General Provider Information

NPI Number : 1629533526
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAYA HELEN HERZOG OTR/L
Provider Business Mailing Address
First Line : 4907 37TH AVE S
Second Line :
City : SEATTLE
State : WA
Zip : 98118-1720
Country : US
Telephone Number : 917-517-9036
Fax Number :
Provider Business Practice Location Address
First Line : 4636 E MARGINAL WAY S STE B100
Second Line :
City : SEATTLE
State : WA
Zip : 98134-2322
Country : US
Telephone Number : 206-763-0352
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2019
Last Update Date : 02/05/2019

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