Provider Demographics
NPI:1538650957
Name:HURTADO, FERNANDO (OTR/L, OTD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:HURTADO
Suffix:
Gender:M
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BIRCH TRL
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-4478
Mailing Address - Country:US
Mailing Address - Phone:224-465-1765
Mailing Address - Fax:
Practice Address - Street 1:8 BIRCH TRL
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-4478
Practice Address - Country:US
Practice Address - Phone:224-465-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2022-12-27
Deactivation Date:2022-12-11
Deactivation Code:
Reactivation Date:2022-12-21
Provider Licenses
StateLicense IDTaxonomies
IL056.014679225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist