Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1197 | PR |
NPI | 1003383399 |
---|---|
Provider Name | Deily Santiago Suarez |
First Address | Santa Isabel, PR 00757 |
Second Address | Coamo, PR 00769-0073 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2018 |
Last Update Date | 01/11/2021 |