Provider Demographics
NPI:1194058982
Name:FERNANDEZ, MA KATHERINE C (OTR)
Entity type:Individual
Prefix:
First Name:MA KATHERINE
Middle Name:C
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 HEATHERBROOKE LN
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-9702
Mailing Address - Country:US
Mailing Address - Phone:785-380-3284
Mailing Address - Fax:
Practice Address - Street 1:1013 RIVERBURCH PKWY
Practice Address - Street 2:SUITE 4
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-8887
Practice Address - Country:US
Practice Address - Phone:866-261-8090
Practice Address - Fax:706-226-7869
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT04545225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist