Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 819 | PR |
NPI | 1023385432 |
---|---|
Provider Name | Ms. Giselle Vazquez |
First Address | Humacao, PR 00791-9746 |
Second Address | Humacao, PR 00791-9746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2011 |
Last Update Date | 30/11/2011 |