Provider Demographics
NPI:1891865242
Name:HERNANDEZ, MICHELE (OT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1772
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-7772
Mailing Address - Country:US
Mailing Address - Phone:850-682-7772
Mailing Address - Fax:888-308-1539
Practice Address - Street 1:728 N FERDON BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-2155
Practice Address - Country:US
Practice Address - Phone:850-682-7772
Practice Address - Fax:888-308-1539
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist