Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1097 | PR |
N | 225XM0800X | Mental Health | 1097 | PR |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 1097 | PR |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 1097 | PR |
N | 225XP0200X | Occupational Therapist - Pediatrics | 1097 | PR |
NPI | 1861624454 |
---|---|
Provider Name | Annie Agosto |
First Address | Ceiba, PR 00735-3175 |
Second Address | Ceiba, PR 00735-3175 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2009 |
Last Update Date | 28/12/2020 |