MEDICARE: JESSICA 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	OT17676	FL

General Provider Information

NPI Number	:	1972964336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA HERNANDEZ OTR/L

Provider Business Mailing Address
First Line	:	15620 SW 10TH LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33194-2755
Country	:	US
Telephone Number	:	305-878-4832
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 W 49TH ST STE 332
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3489
Country	:	US
Telephone Number	:	786-789-5305
Fax Number	:	786-789-5315

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

Provider Enumeration Date	:	03/14/2016
Last Update Date	:	09/16/2021

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