Provider Demographics
NPI:1730393497
Name:HERMAN, MOJCA C (MA, OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:MOJCA
Middle Name:C
Last Name:HERMAN
Suffix:
Gender:F
Credentials:MA, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 S IRENA AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5104
Mailing Address - Country:US
Mailing Address - Phone:424-218-9959
Mailing Address - Fax:310-388-6416
Practice Address - Street 1:1450 S IRENA AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5104
Practice Address - Country:US
Practice Address - Phone:310-698-2008
Practice Address - Fax:310-388-6416
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Single Specialty
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomicsGroup - Single Specialty
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164919OtherFIRST HEALTH PIN
OT0000170OtherBLUE SHIELD
300819400OtherDEPT OF LABOR PIN
7507553OtherAETNA PIN
P00229468OtherMEDICARE PIN-PALMETTO GBA
5116420001Medicare NSC
300819400OtherDEPT OF LABOR PIN