MEDICARE: SOL MARIA HERNANDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224ZF0002X	Feeding, Eating & Swallowing Occupational Therapy Assistant	214708	TX
2	224Z00000X	Occupational Therapy Assistant	214708	TX

General Provider Information

NPI Number	:	1336782457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOL MARIA HERNANDEZ

Provider Business Mailing Address
First Line	:	210 EDWARDS ST
Second Line	:
City	:	REFUGIO
State	:	TX
Zip	:	78377-2616
Country	:	US
Telephone Number	:	361-660-6809
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 E MOCKINGBIRD LN
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904-2437
Country	:	US
Telephone Number	:	361-573-3201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2019
Last Update Date	:	10/21/2019

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Directions to “ SOL MARIA HERNANDEZ ” Practice Location

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