Provider Demographics
NPI:1831073113
Name:HERZIG, KATHERINE ANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:HERZIG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2167
Mailing Address - Country:US
Mailing Address - Phone:207-572-6484
Mailing Address - Fax:
Practice Address - Street 1:11 ROCK ROW STE 220
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4877
Practice Address - Country:US
Practice Address - Phone:207-464-7076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT4872225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist