Provider Demographics
NPI:1558637736
Name:HERNANDEZ, TAISHA LEE (OTR/L)
Entity type:Individual
Prefix:
First Name:TAISHA
Middle Name:LEE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 UNDERCLIFF AVE
Mailing Address - Street 2:APT.3A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-7176
Mailing Address - Country:US
Mailing Address - Phone:347-664-4192
Mailing Address - Fax:
Practice Address - Street 1:1655 UNDERCLIFF AVE
Practice Address - Street 2:APT.3A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-7176
Practice Address - Country:US
Practice Address - Phone:347-664-4192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-01
Last Update Date:2012-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016851-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist