Provider Demographics
NPI:1326462615
Name:HERRON, VICTORIA (OT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:HERRON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:542 KIRKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-6457
Mailing Address - Country:US
Mailing Address - Phone:606-280-0462
Mailing Address - Fax:
Practice Address - Street 1:542 KIRKWOOD DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-6457
Practice Address - Country:US
Practice Address - Phone:606-280-0462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR5755225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist