Provider Demographics
NPI:1710505243
Name:HERARD, MARTH EILEEN (COTA)
Entity Type:Individual
Prefix:MS
First Name:MARTH
Middle Name:EILEEN
Last Name:HERARD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 RICHMOND HWY APT 432
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-1765
Mailing Address - Country:US
Mailing Address - Phone:561-801-2849
Mailing Address - Fax:
Practice Address - Street 1:5901 MACARTHUR BLVD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2541
Practice Address - Country:US
Practice Address - Phone:202-349-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002373224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant