Provider Demographics
NPI:1467992495
Name:URENA, GLENDA (OT1070/SI4931)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:URENA
Suffix:
Gender:F
Credentials:OT1070/SI4931
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 1585
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-1585
Mailing Address - Country:US
Mailing Address - Phone:787-413-3269
Mailing Address - Fax:
Practice Address - Street 1:H53 AVE FRONTERA
Practice Address - Street 2:URB VILLA ANDALUCIA LATORRE'S BUILDING
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-224-7468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1070225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist