Provider Demographics
NPI:1619521630
Name:OTERO, REYNALDO SR (THL)
Entity Type:Individual
Prefix:
First Name:REYNALDO
Middle Name:
Last Name:OTERO
Suffix:SR
Gender:M
Credentials:THL
Other - Prefix:
Other - First Name:REYNALDO
Other - Middle Name:
Other - Last Name:OTERO
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:214 URB VILLA PINARES
Mailing Address - Street 2:PASEO CIPRES
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:939-254-0060
Mailing Address - Fax:
Practice Address - Street 1:214 URB VILLA PINARES
Practice Address - Street 2:PASEO CIPRES
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:939-254-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR72172355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7217OtherTHL