Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 928 | PR |
NPI | 1043541592 |
---|---|
Provider Name | Mrs. Carmen Doris Carrasquillo |
First Address | Las Piedras, PR 00771-9236 |
Second Address | Caguas, PR 00725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2010 |
Last Update Date | 22/01/2010 |