Provider Demographics
NPI:1821222977
Name:HERRERA, FRANKLIN DAGAAS JR (OT)
Entity Type:Individual
Prefix:MR
First Name:FRANKLIN
Middle Name:DAGAAS
Last Name:HERRERA
Suffix:JR
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2004 MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1252
Mailing Address - Country:US
Mailing Address - Phone:660-541-0456
Mailing Address - Fax:417-782-7038
Practice Address - Street 1:214 W 5TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-2501
Practice Address - Country:US
Practice Address - Phone:417-782-2917
Practice Address - Fax:417-782-7038
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005010642225X00000X
OK1512225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist