Provider Demographics
NPI:1720467830
Name:HERNANDEZ, MEGAN LENORE (COTA)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LENORE
Last Name:HERNANDEZ
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 1:4150 NE LAURA ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6357
Mailing Address - Country:US
Mailing Address - Phone:503-953-2115
Mailing Address - Fax:
Practice Address - Street 1:650 SE OAK ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4120
Practice Address - Country:US
Practice Address - Phone:503-953-2115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR314593224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR314593OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY
OR314593OtherOCCUPATIONAL THERAPY LICENSING BOARD