Provider Demographics
NPI:1992849590
Name:HEROLD-MAHO, JANICE KAY (OTR-L)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:KAY
Last Name:HEROLD-MAHO
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:KAY
Other - Last Name:HEROLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR-L
Mailing Address - Street 1:551 LITTLE CANADA RD E
Mailing Address - Street 2:
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55117-1633
Mailing Address - Country:US
Mailing Address - Phone:651-490-5205
Mailing Address - Fax:
Practice Address - Street 1:2495 MAPLEWOOD DRIVE
Practice Address - Street 2:SUITE 313
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1913
Practice Address - Country:US
Practice Address - Phone:651-770-8884
Practice Address - Fax:651-770-8151
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100855225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics