Provider Demographics
NPI:1285836668
Name:MERCADO, DIANA (OTL)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:MERCADO
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 CALLE MONTE ARARAT
Mailing Address - Street 2:URB. MONTE VERDE
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-5732
Mailing Address - Country:US
Mailing Address - Phone:787-884-5728
Mailing Address - Fax:
Practice Address - Street 1:509 CALLE MONTE ARARAT
Practice Address - Street 2:URB. MONTE VERDE
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-5732
Practice Address - Country:US
Practice Address - Phone:787-884-5728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR466225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist