Provider Demographics
NPI:1316208010
Name:WEATHERFORD, HERBERT PIERRE JR (COTA)
Entity Type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:PIERRE
Last Name:WEATHERFORD
Suffix:JR
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:813 AUDUBON DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-6961
Mailing Address - Country:US
Mailing Address - Phone:317-252-3941
Mailing Address - Fax:
Practice Address - Street 1:12332 TEACUP WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-6128
Practice Address - Country:US
Practice Address - Phone:317-702-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY266539224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant