Provider Demographics
NPI:1295958999
Name:HERNANDEZ, IRIS L (OTR)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:L
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12857 RAYSBROOK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-8718
Mailing Address - Country:US
Mailing Address - Phone:813-671-4672
Mailing Address - Fax:
Practice Address - Street 1:1513 SUN CITY CENTER PLZ
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5390
Practice Address - Country:US
Practice Address - Phone:813-634-6022
Practice Address - Fax:813-634-6053
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT2962225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist