Provider Demographics
NPI:1780073403
Name:HERRON, JAN L (OTR/L)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:L
Last Name:HERRON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 N 93RD ST APT 2B8
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2675
Mailing Address - Country:US
Mailing Address - Phone:303-910-1847
Mailing Address - Fax:
Practice Address - Street 1:1018 DODGE ST
Practice Address - Street 2:SUITE #6
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-1125
Practice Address - Country:US
Practice Address - Phone:402-995-9874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1709225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology