Provider Demographics
NPI:1891972840
Name:HERRO, MARLEEN GRACE (OTR/L,CHT,CLT-LANA)
Entity Type:Individual
Prefix:
First Name:MARLEEN
Middle Name:GRACE
Last Name:HERRO
Suffix:
Gender:F
Credentials:OTR/L,CHT,CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4918 PAYSON WAY SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7379
Mailing Address - Country:US
Mailing Address - Phone:480-695-9493
Mailing Address - Fax:
Practice Address - Street 1:1810 WHITE CIR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-5835
Practice Address - Country:US
Practice Address - Phone:770-426-9945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0798225XH1200X
GAOT005370225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand