Individual
SHAQUAIL HERRON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2564 FOX POINTE DR, COLUMBUS, IN 47203-3181
(812) 372-0950
Mailing address
4950 E 18TH ST, INDIANAPOLIS, IN 46218-4675
(317) 993-9025
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32002643A
IN
Other
Enumeration date
06/29/2014
Last updated
06/29/2014
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