Provider Demographics
NPI:1477078582
Name:FERNANDEZ, BIANCA CELYN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:BIANCA
Middle Name:CELYN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HENRY ST APT 3612
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-5885
Mailing Address - Country:US
Mailing Address - Phone:914-584-7039
Mailing Address - Fax:
Practice Address - Street 1:2875 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4204
Practice Address - Country:US
Practice Address - Phone:203-336-0232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4268225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist