Provider Demographics
NPI:1891575528
Name:KANDRASHOFF, FERNANDA A
Entity Type:Individual
Prefix:
First Name:FERNANDA
Middle Name:A
Last Name:KANDRASHOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151 S BABCOCK ST APT 42
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-6956
Mailing Address - Country:US
Mailing Address - Phone:772-486-6585
Mailing Address - Fax:
Practice Address - Street 1:1005 BARBER ST
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-5560
Practice Address - Country:US
Practice Address - Phone:772-202-8622
Practice Address - Fax:772-925-8332
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA19645224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant