Provider Demographics
NPI:1073868311
Name:HORNEDO, OMNI (OTA)
Entity Type:Individual
Prefix:
First Name:OMNI
Middle Name:
Last Name:HORNEDO
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 CLAREMONT AVE
Mailing Address - Street 2:#1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4635
Mailing Address - Country:US
Mailing Address - Phone:646-761-2965
Mailing Address - Fax:
Practice Address - Street 1:160 CLAREMONT AVE
Practice Address - Street 2:#1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4635
Practice Address - Country:US
Practice Address - Phone:646-761-2965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007868-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant