Provider Demographics
NPI:1851492110
Name:HERDT, HEATHER GRIFFIN (MSR,OTR/L)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:GRIFFIN
Last Name:HERDT
Suffix:
Gender:F
Credentials:MSR,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BLASSINGAME RD
Mailing Address - Street 2:GREENVILLE COUNTY SCHOOL DISTRICT
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-3304
Mailing Address - Country:US
Mailing Address - Phone:864-355-3100
Mailing Address - Fax:
Practice Address - Street 1:100 BLASSINGAME RD
Practice Address - Street 2:GREENVILLE COUNTY SCHOOL DISTRICT
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-3304
Practice Address - Country:US
Practice Address - Phone:864-355-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2544225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0334Medicaid
SCTH1259Medicaid
SCTH1259Medicaid