Provider Demographics
NPI:1972263028
Name:FERNANDEZ, STEPHANIE (COTA/L)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13900 HEYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-6125
Mailing Address - Country:US
Mailing Address - Phone:737-297-2189
Mailing Address - Fax:
Practice Address - Street 1:13900 HEYWOOD DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-6125
Practice Address - Country:US
Practice Address - Phone:737-297-2189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216198224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant