Provider Demographics
NPI:1912288838
Name:HEROLD, RENEE M (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:HEROLD
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 KELLER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1308
Mailing Address - Country:US
Mailing Address - Phone:410-653-3161
Mailing Address - Fax:
Practice Address - Street 1:11 KELLER RD
Practice Address - Street 2:SUITE B
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-1308
Practice Address - Country:US
Practice Address - Phone:410-653-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05959225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics