Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | ||
N | 224Z00000X | Occupational Therapy Assistant | FL |
NPI | 1013405398 |
---|---|
Provider Name | Mirialis Mendez Hernandez |
First Address | Orlando, FL 32825-3503 |
Second Address | Orlando, FL 32825-3503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2018 |
Last Update Date | 23/04/2018 |