Provider Demographics
NPI:1003254160
Name:HERRON, JOHN (LOTR)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HERRON
Suffix:
Gender:M
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6157 AIRPORT BLVD
Mailing Address - Street 2:PO BOX 852022
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36685-5501
Mailing Address - Country:US
Mailing Address - Phone:504-812-1369
Mailing Address - Fax:251-633-8741
Practice Address - Street 1:6157 AIRPORT BLVD
Practice Address - Street 2:SUITE 852022
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36685-5501
Practice Address - Country:US
Practice Address - Phone:504-812-1369
Practice Address - Fax:251-633-8741
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3180225X00000X
225XE0001X, 225XE1200X, 225XF0002X, 225XG0600X, 225XH1200X, 225XH1300X, 225XL0004X, 225XM0800X, 225XN1300X, 225XP0019X, 225XR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XH1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHuman Factors
No225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility