Provider Demographics
NPI:1932349388
Name:HERNANDEZ, MARIA DE JESUS (OTR)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DE JESUS
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 1:635 SE 5TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5433
Mailing Address - Country:US
Mailing Address - Phone:786-239-5834
Mailing Address - Fax:305-228-6251
Practice Address - Street 1:3860 SW 137TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6462
Practice Address - Country:US
Practice Address - Phone:305-385-0168
Practice Address - Fax:305-385-0182
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13506225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist