Provider Demographics
NPI:1104264951
Name:HERRERA, VERONICA
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 CONARD AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-3917
Mailing Address - Country:US
Mailing Address - Phone:620-338-6665
Mailing Address - Fax:
Practice Address - Street 1:620 E WOOD ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:KS
Practice Address - Zip Code:67026-9757
Practice Address - Country:US
Practice Address - Phone:620-338-6665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1800409224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant