Provider Demographics
NPI:1134296833
Name:MATOS COTTO, BRENDA IVELISSE (TO)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:IVELISSE
Last Name:MATOS COTTO
Suffix:
Gender:F
Credentials:TO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 360325
Mailing Address - Street 2:SER DE PUERTO RICO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-0325
Mailing Address - Country:US
Mailing Address - Phone:787-767-6710
Mailing Address - Fax:787-758-0950
Practice Address - Street 1:CALLE JULIO CINTRON #202
Practice Address - Street 2:EDIFICIO GUAYACAN SUITE 221 SER DE PUERTO RICO
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-735-0290
Practice Address - Fax:787-735-0380
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist