Individual
DEBORAH J HERZOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
3811 W 52ND ST, ROELAND PARK, KS 66205-1458
(913) 579-8556
Mailing address
3811 W 52ND ST, ROELAND PARK, KS 66205-1458
(913) 579-8556
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
17-00917
KS
225X00000X
Occupational Therapist
2004028607
MO
225XP0200X
Pediatric Occupational Therapist
17-00917
KS
225XP0200X
Pediatric Occupational Therapist
2004028607
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201858547
GREAT-WEST HC PROVIDER #
MO
01
—
34948018
BCBS KANSAS CITY #
MO
Enumeration date
06/28/2005
Last updated
12/30/2022
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