Provider Demographics
NPI:1235401647
Name:HERNANDEZ, MELISSA ACOSTA (OTR/L, LLCC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ACOSTA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:OTR/L, LLCC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:ACOSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:6500 SW 152ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2159
Mailing Address - Country:US
Mailing Address - Phone:319-855-8098
Mailing Address - Fax:
Practice Address - Street 1:3901 NW 79TH AVE STE 122
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6554
Practice Address - Country:US
Practice Address - Phone:319-855-8098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16667225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist