Provider Demographics
NPI:1497265193
Name:HERNANDEZ, HARAMI (OT)
Entity Type:Individual
Prefix:
First Name:HARAMI
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2971 NW 159TH ST
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-6833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4975 GRAND PAVILLION WAY
Practice Address - Street 2:APT 422
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22303
Practice Address - Country:US
Practice Address - Phone:202-590-0278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-07
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT16323225X00000X
VA0119-009575225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889063300Medicaid