Provider Demographics
NPI:1851252761
Name:HERROD, BLAIR ELIZABETH (MSOT, OTR/L)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:ELIZABETH
Last Name:HERROD
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 LAKEMONT DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-7733
Mailing Address - Country:US
Mailing Address - Phone:770-628-1500
Mailing Address - Fax:770-628-1050
Practice Address - Street 1:239 VILLAGE CENTER PKWY STE 190
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6396
Practice Address - Country:US
Practice Address - Phone:770-628-1500
Practice Address - Fax:770-628-1050
Is Sole Proprietor?:No
Enumeration Date:2025-11-20
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT009724225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist