Provider Demographics
NPI:1407516867
Name:RUIZ MARQUEZ, KENNETH NOEL (MS, OTR/L, THL)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:NOEL
Last Name:RUIZ MARQUEZ
Suffix:
Gender:M
Credentials:MS, OTR/L, THL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VILLAS CENTRAL VICTORIA
Mailing Address - Street 2:H-18 PASEO MELAO 104
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-4532
Mailing Address - Country:US
Mailing Address - Phone:939-244-6262
Mailing Address - Fax:
Practice Address - Street 1:AV. LUIS VIGOREAUX
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:939-244-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR72252355S0801X
PR1035-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant