Provider Demographics
NPI:1821142399
Name:FERNANDEZ, ROBERT N
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:N
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 PIONEER PATH
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-8174
Mailing Address - Country:US
Mailing Address - Phone:336-877-2594
Mailing Address - Fax:336-877-2549
Practice Address - Street 1:285 PIONEER PATH
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-8174
Practice Address - Country:US
Practice Address - Phone:336-877-2594
Practice Address - Fax:336-877-2549
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2108225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist