Provider Demographics
NPI:1437792868
Name:HERAMAN, TYLAR K (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:TYLAR
Middle Name:K
Last Name:HERAMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4916 E MICHIGAN ST APT 10
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-5252
Mailing Address - Country:US
Mailing Address - Phone:904-294-5569
Mailing Address - Fax:
Practice Address - Street 1:950 S MELLONVILLE AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-2237
Practice Address - Country:US
Practice Address - Phone:407-322-8566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT20359225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist