=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093016164
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA FERNANDEZ OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2010
-----------------------------------------------------
Last Update Date | 03/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7252 METROPOLITAN AVE
-----------------------------------------------------
City | MIDDLE VILLAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11379-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-326-0055
-----------------------------------------------------
Fax | 718-326-0637
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7125 MAIN ST
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11367-2014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-261-0211
-----------------------------------------------------
Fax | 718-268-0556
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 015324-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 015324-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------