Provider Demographics
NPI:1073222378
Name:HERNANDEZ, BETHANIE VICTORIA (OTR/L, OTD)
Entity Type:Individual
Prefix:
First Name:BETHANIE
Middle Name:VICTORIA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2577 MOLINE ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-1373
Mailing Address - Country:US
Mailing Address - Phone:210-838-1097
Mailing Address - Fax:
Practice Address - Street 1:2577 MOLINE ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-1373
Practice Address - Country:US
Practice Address - Phone:210-838-1097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0007658225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist