Provider Demographics
NPI:1518597921
Name:HEROLD, GIDGETT R (COTA/L)
Entity Type:Individual
Prefix:
First Name:GIDGETT
Middle Name:R
Last Name:HEROLD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7428 SCIOTO PKWY
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7492
Mailing Address - Country:US
Mailing Address - Phone:614-795-1310
Mailing Address - Fax:
Practice Address - Street 1:170 TAYLOR STATION RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4491
Practice Address - Country:US
Practice Address - Phone:614-866-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant