Provider Demographics
NPI:1144973181
Name:FERNANDEZ, YENIBY (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:YENIBY
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4703 FOXSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-4307
Mailing Address - Country:US
Mailing Address - Phone:813-399-9711
Mailing Address - Fax:813-873-8837
Practice Address - Street 1:16102 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-6129
Practice Address - Country:US
Practice Address - Phone:813-873-1936
Practice Address - Fax:813-873-8837
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT22711225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist