Provider Demographics
NPI:1043779358
Name:HERTZ, STEVEN NICHOLAS (OTR)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:NICHOLAS
Last Name:HERTZ
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 45TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8970
Mailing Address - Country:US
Mailing Address - Phone:701-356-4384
Mailing Address - Fax:701-356-4383
Practice Address - Street 1:3401 45TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8970
Practice Address - Country:US
Practice Address - Phone:701-356-4384
Practice Address - Fax:701-356-4383
Is Sole Proprietor?:No
Enumeration Date:2019-03-16
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1787225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist