Provider Demographics
NPI:1255670451
Name:HERRERA, STEPHANIE ANNE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANNE
Last Name:HERRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 21ST ST
Mailing Address - Street 2:STE. 210
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-1697
Mailing Address - Country:US
Mailing Address - Phone:409-443-1126
Mailing Address - Fax:
Practice Address - Street 1:101 21ST ST
Practice Address - Street 2:STE. 210
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-1697
Practice Address - Country:US
Practice Address - Phone:409-443-1126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114448225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist