Provider Demographics
NPI:1740415421
Name:HERNANDEZ, MELISSA (OTR)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MADISON AVE APT 6M
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3413
Mailing Address - Country:US
Mailing Address - Phone:917-968-1049
Mailing Address - Fax:917-265-4994
Practice Address - Street 1:220 MADISON AVE APT 6M
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3413
Practice Address - Country:US
Practice Address - Phone:917-968-1049
Practice Address - Fax:917-265-4994
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-24
Last Update Date:2009-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13625225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist