Provider Demographics
NPI:1033420088
Name:STILWELL-HERNANDEZ, KEILA YAMICHA (OT)
Entity Type:Individual
Prefix:MRS
First Name:KEILA
Middle Name:YAMICHA
Last Name:STILWELL-HERNANDEZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27925 SW 165TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33031-2854
Mailing Address - Country:US
Mailing Address - Phone:386-837-5405
Mailing Address - Fax:
Practice Address - Street 1:151 NW 11TH ST STE W201
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4361
Practice Address - Country:US
Practice Address - Phone:786-269-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1532224Z00000X
FL16059225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1033420088Medicaid