Provider Demographics
NPI:1154443133
Name:MERCADO, ROSA (OTR)
Entity Type:Individual
Prefix:MS
First Name:ROSA
Middle Name:
Last Name:MERCADO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:OQ2 CALLE 520
Mailing Address - Street 2:URB. COUNTRY CLUB
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-1916
Mailing Address - Country:US
Mailing Address - Phone:787-649-5374
Mailing Address - Fax:
Practice Address - Street 1:265 AVE WINSTON CHURCHILL
Practice Address - Street 2:EL SENORIAL
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00926-6604
Practice Address - Country:US
Practice Address - Phone:787-649-5374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR421225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist