Provider Demographics
NPI:1720540487
Name:HER-LO, MAULY (OTR/L)
Entity Type:Individual
Prefix:
First Name:MAULY
Middle Name:
Last Name:HER-LO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MAU;Y
Other - Middle Name:
Other - Last Name:HER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8500 S SPRINGBROOK BLVD APT 213
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-2963
Mailing Address - Country:US
Mailing Address - Phone:414-759-6986
Mailing Address - Fax:
Practice Address - Street 1:3005 S RIVERSIDE DR STE 103
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1500
Practice Address - Country:US
Practice Address - Phone:608-313-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6494-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist