Provider Demographics
NPI:1346578382
Name:GAVILAN MERCADO, MELISSA (OTL)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:GAVILAN 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 1:705 CALLE PALMA
Mailing Address - Street 2:COCO BEACH
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-4647
Mailing Address - Country:US
Mailing Address - Phone:787-209-0098
Mailing Address - Fax:
Practice Address - Street 1:PLAZA SAN MIGUEL # 160
Practice Address - Street 2:MARGINAL LAGO ALTO SUITE 207
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-3906
Practice Address - Country:US
Practice Address - Phone:787-292-2534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR810225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics