Provider Demographics
NPI:1689897712
Name:HERNANDEZ, STEPHANIE A (OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:HERNANDEZ
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 1:726 SPRING ISLAND WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8482
Mailing Address - Country:US
Mailing Address - Phone:407-927-7404
Mailing Address - Fax:
Practice Address - Street 1:726 SPRING ISLAND WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8482
Practice Address - Country:US
Practice Address - Phone:407-927-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9137225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888257600Medicaid