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NPI Code Detail

MEDICARE: MR. JOSE ANGEL HERNANDEZ JR. OTR

MEDICARE: MR. JOSE ANGEL HERNANDEZ JR. OTR
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
1225X00000XOccupational Therapist119769TX

General Provider Information

NPI Number : 1679125249
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSE ANGEL HERNANDEZ JR. OTR
Provider Business Mailing Address
First Line : 1424 HEMPHILL ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4703
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4443 N JOSEY LN STE 100
Second Line :
City : CARROLLTON
State : TX
Zip : 75010-4677
Country : US
Telephone Number : 972-394-8900
Fax Number : 972-394-6266
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2019
Last Update Date : 07/12/2019

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