Provider Demographics
NPI:1639501216
Name:MUNOZ, MILDRED IVELISSE (OT)
Entity Type:Individual
Prefix:MS
First Name:MILDRED
Middle Name:IVELISSE
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:OT
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 1284
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-1284
Mailing Address - Country:US
Mailing Address - Phone:787-645-9481
Mailing Address - Fax:787-868-3611
Practice Address - Street 1:CALLE COLON NUMERO 99 INT
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-645-9481
Practice Address - Fax:787-868-3611
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR671225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist