Provider Demographics
NPI:1790205391
Name:FERNANDEZ, JIANNA D (OTD/L)
Entity Type:Individual
Prefix:
First Name:JIANNA
Middle Name:D
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:OTD/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 S JEFFERSON AVE # 145
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-3119
Mailing Address - Country:US
Mailing Address - Phone:314-265-3819
Mailing Address - Fax:
Practice Address - Street 1:8506 ANNA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-5205
Practice Address - Country:US
Practice Address - Phone:314-265-3819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7041225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist