Healthcare Provider Details

I. General information

NPI: 1538650957
Provider Name (Legal Business Name): FERNANDO HURTADO OTR/L, OTD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date: 12/11/2022
Reactivation Date: 12/21/2022

III. Provider practice location address

8 BIRCH TRL
WHEELING IL
60090-4478
US

IV. Provider business mailing address

8 BIRCH TRL
WHEELING IL
60090-4478
US

V. Phone/Fax

Practice location:
  • Phone: 224-465-1765
  • Fax:
Mailing address:
  • Phone: 224-465-1765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.014679
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: