Provider Demographics
NPI:1598587586
Name:HERRERA, ERIKA ROSE (OTRL)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:ROSE
Last Name:HERRERA
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:ROSE
Other - Last Name:BEALS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:9724 RUTH AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101
Mailing Address - Country:US
Mailing Address - Phone:313-354-4502
Mailing Address - Fax:
Practice Address - Street 1:3420 WEST ROAD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183
Practice Address - Country:US
Practice Address - Phone:734-671-1923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201012817225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist