Provider Demographics
NPI: | 1144763681 |
---|---|
Name: | HERNANDEZ, KRYSTINA |
Entity Type: | Individual |
Prefix: | |
First Name: | KRYSTINA |
Middle Name: | |
Last Name: | HERNANDEZ |
Suffix: | |
Gender: | F |
Credentials: | |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1001 SW 189TH AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | PEMBROKE PINES |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33029-6052 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 954-643-0382 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1001 SW 189TH AVE |
Practice Address - Street 2: | |
Practice Address - City: | PEMBROKE PINES |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33029-6052 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-643-0382 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2016-12-01 |
Last Update Date: | 2017-02-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | MA61486 | 225700000X |
FL | OT16659 | 225X00000X, 225XE0001X, 225XF0002X, 225XN1300X, 225XP0019X, 225XP0200X |
222Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | |
No | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | |
No | 225XE0001X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Environmental Modification |
No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing |
No | 225XN1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation |
No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No | 222Q00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist |