Provider Demographics
NPI:1316729338
Name:HERNANDEZ, YEVGENIA (OTR/L)
Entity type:Individual
Prefix:
First Name:YEVGENIA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:YEVGENIA
Other - Middle Name:
Other - Last Name:TISSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:951-374-7288
Mailing Address - Fax:
Practice Address - Street 1:340 DOGWOOD AVE STE 105
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3400
Practice Address - Country:US
Practice Address - Phone:516-437-5300
Practice Address - Fax:516-437-2936
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022409-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist