Provider Demographics
NPI:1063672301
Name:MENDEZ, ITAMAR (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ITAMAR
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 25688
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9845
Mailing Address - Country:US
Mailing Address - Phone:787-546-4402
Mailing Address - Fax:
Practice Address - Street 1:HC 5 BOX 25688
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-9845
Practice Address - Country:US
Practice Address - Phone:787-546-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1024225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist