Active NPI
Deborah J Herzog, OTR/L
- Occupational Therapist
- Roeland Park, KS
National Provider Identifier
1164428751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 17-00917
- Practice address
- 3811 W 52ND St
Roeland Park, KS 66205-1458 - Phone
- (913) 579-8556
- NPI assigned
- Jun 28, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 2004028607 | MO | |
| Pediatric Occupational Therapist | 225XP0200X | 17-00917 | KS | |
| Pediatric Occupational Therapist | 225XP0200X | 2004028607 | MO | |
| Occupational Therapist | 225X00000X | 17-00917 | KS | Primary |
Addresses
Primary practice location
3811 W 52ND St
Roeland Park, KS 66205-1458
Mailing address
3811 W 52ND St
Roeland Park, KS 66205-1458
Phone (913) 579-8556
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201858547 | Other | MO | GREAT-WEST HC PROVIDER # |
| 34948018 | Other | MO | BCBS KANSAS CITY # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2004028607 | MO | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672358400000",
"number": "1164428751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3811 W 52ND ST",
"city": "ROELAND PARK",
"state": "KS",
"postal_code": "662051458",
"telephone_number": "913-579-8556"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3811 W 52ND ST",
"city": "ROELAND PARK",
"state": "KS",
"postal_code": "662051458",
"telephone_number": "913-579-8556"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERZOG",
"first_name": "DEBORAH",
"middle_name": "J",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-06-28",
"last_updated": "2022-12-30",
"certification_date": "2022-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MO",
"license": "2004028607",
"primary": false
},
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "KS",
"license": "17-00917",
"primary": false
},
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "MO",
"license": "2004028607",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "KS",
"license": "17-00917",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GREAT-WEST HC PROVIDER #",
"identifier": "201858547",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS KANSAS CITY #",
"identifier": "34948018",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roeland Park, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.