Provider Demographics
NPI:1306267117
Name:FERNANDEZ, OLGA (COTA)
Entity type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W CHAMP CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-1219
Mailing Address - Country:US
Mailing Address - Phone:575-746-2777
Mailing Address - Fax:
Practice Address - Street 1:801 W CHAMP CLARK AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1219
Practice Address - Country:US
Practice Address - Phone:575-746-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1015224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant