Provider Demographics
NPI:1134741531
Name:HERRERA, CARLOS (OT)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:HERRERA
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 CHERRY RIDGE ST STE 323C
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4831
Mailing Address - Country:US
Mailing Address - Phone:210-349-1415
Mailing Address - Fax:
Practice Address - Street 1:3201 CHERRY RIDGE ST STE 323C
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4831
Practice Address - Country:US
Practice Address - Phone:210-349-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120558225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist