Provider Demographics
NPI:1609322379
Name:HERRERA, PRECIOUS AMETHYST (OTR/L)
Entity Type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:AMETHYST
Last Name:HERRERA
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 1:2218 41ST ST
Mailing Address - Street 2:APT 2R
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1797
Mailing Address - Country:US
Mailing Address - Phone:510-206-1241
Mailing Address - Fax:
Practice Address - Street 1:2218 41ST ST
Practice Address - Street 2:APT 2R
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1797
Practice Address - Country:US
Practice Address - Phone:510-206-1241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0205681225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist