Provider Demographics
NPI:1447822390
Name:FERNANDEZ, EMERALD (OTR, OTD)
Entity type:Individual
Prefix:
First Name:EMERALD
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:OTR, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 AUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:GODLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76044-3868
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7217 HAWKINS VIEW DR STE 201
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3928
Practice Address - Country:US
Practice Address - Phone:817-479-7019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121935225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist