Provider Demographics
NPI:1184780157
Name:HERNANDEZ, BARBARA M (MS, OTRL)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:M
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9920 LAGO DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-2770
Mailing Address - Country:US
Mailing Address - Phone:561-306-7199
Mailing Address - Fax:
Practice Address - Street 1:9920 LAGO DR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-2770
Practice Address - Country:US
Practice Address - Phone:561-306-7199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10994225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL289049OtherAMERIGROUP FLORIDA, INC.
FL289049OtherAMERIGROUP FLORIDA, INC.