Individual
LIDA EUDALY FERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
329 VINE ST, ELIZABETH, NJ 07202-1817
(908) 906-0978
Mailing address
329 VINE ST, ELIZABETH, NJ 07202-1817
(908) 906-0978
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR00354400
NJ
Other
Enumeration date
09/30/2019
Last updated
09/30/2019
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