Provider Demographics
NPI:1396008728
Name:HERREMA, MATTHEW PAUL (MS, AT, ATC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PAUL
Last Name:HERREMA
Suffix:
Gender:M
Credentials:MS, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-3527
Mailing Address - Country:US
Mailing Address - Phone:616-780-2134
Mailing Address - Fax:
Practice Address - Street 1:2200 N SQUIRREL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48309-4402
Practice Address - Country:US
Practice Address - Phone:248-370-3998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010007082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer