Provider Demographics
NPI:1750666541
Name:HERNANDEZ, MICHELE MOTRIA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:MOTRIA
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 1:102 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:WENONAH
Mailing Address - State:NJ
Mailing Address - Zip Code:08090-1726
Mailing Address - Country:US
Mailing Address - Phone:609-634-3588
Mailing Address - Fax:
Practice Address - Street 1:102 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:WENONAH
Practice Address - State:NJ
Practice Address - Zip Code:08090-1726
Practice Address - Country:US
Practice Address - Phone:609-634-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00164000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist