Individual
MRS. STACEY KATHLEEN HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2203 BABCOCK RD, SAN ANTONIO, TX 78229-4412
(210) 614-3911
(210) 616-0443
Mailing address
2203 BABCOCK RD, SAN ANTONIO, TX 78229-4412
(210) 614-3911
(210) 616-0443
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
110793
TX
225XP0200X
Pediatric Occupational Therapist
Primary
110793
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177250101
—
TX
Enumeration date
06/16/2008
Last updated
07/21/2022
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