Provider Demographics
NPI:1578727723
Name:HERBERG, MARY BETH (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BETH
Last Name:HERBERG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:DEGEETER-HERBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1100 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1838
Mailing Address - Country:US
Mailing Address - Phone:502-596-1000
Mailing Address - Fax:502-596-1411
Practice Address - Street 1:1100 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1838
Practice Address - Country:US
Practice Address - Phone:502-596-1000
Practice Address - Fax:502-596-1411
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R0153225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist