MEDICARE: ERIKA HERNANDEZ OTR/L

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	225X00000X	Occupational Therapist	3038	NM
2	225X00000X	Occupational Therapist	OT3038	NM

General Provider Information

NPI Number	:	1962743880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA HERNANDEZ OTR/L

Provider Business Mailing Address
First Line	:	301 PERKINS DR
Second Line	:	STE C
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3248
Country	:	US
Telephone Number	:	575-523-7243
Fax Number	:	575-525-5641

Provider Business Practice Location Address
First Line	:	1090 MED PARK DR
Second Line	:	STE A
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3226
Country	:	US
Telephone Number	:	575-523-7243
Fax Number	:	575-525-5641

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

Provider Enumeration Date	:	03/04/2013
Last Update Date	:	03/24/2022

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