Provider Demographics
NPI:1275851750
Name:FERNANDEZ, VICTORIA AUTUMN (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:AUTUMN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13563 SW 109TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-6000
Mailing Address - Country:US
Mailing Address - Phone:305-251-3067
Mailing Address - Fax:
Practice Address - Street 1:13563 SW 109TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-6000
Practice Address - Country:US
Practice Address - Phone:305-251-3067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-09
Last Update Date:2010-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14007225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist