Provider Demographics
NPI:1114196078
Name:MERCADO-SANTIAGO, LOURDES MARIA (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:MARIA
Last Name:MERCADO-SANTIAGO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 CASA MARINA PL
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-5228
Mailing Address - Country:US
Mailing Address - Phone:407-595-0753
Mailing Address - Fax:407-324-4590
Practice Address - Street 1:7209 CURRY FORD RD
Practice Address - Street 2:SUITE E
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5809
Practice Address - Country:US
Practice Address - Phone:407-421-7284
Practice Address - Fax:407-382-4210
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA4904224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant