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Individual
HAVEN HERNDON
Active
Individual
HAVEN HERNDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S, OTR/L
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
60936305
WA
225X00000X
Occupational Therapist
Primary
—
NULL
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT2018015
OT STATE MEDICAL LICENSE
AR
Enumeration date
07/23/2018
Last updated
04/08/2019
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