Provider Demographics
NPI:1629533526
Name:HERZOG, MAYA HELEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:HELEN
Last Name:HERZOG
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 1:4907 37TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1720
Mailing Address - Country:US
Mailing Address - Phone:917-517-9036
Mailing Address - Fax:
Practice Address - Street 1:4636 E MARGINAL WAY S STE B100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-2322
Practice Address - Country:US
Practice Address - Phone:206-763-0352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60926626225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist