Provider Demographics
NPI:1679180806
Name:RODRIGUEZ MERCADO, NICOLLE (OTR)
Entity Type:Individual
Prefix:
First Name:NICOLLE
Middle Name:
Last Name:RODRIGUEZ MERCADO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE AUGUSTA 1653
Mailing Address - Street 2:URB. SAN GERARDO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-467-7459
Mailing Address - Fax:
Practice Address - Street 1:EXPRESSO TRUJILLO ALTO PR-181 CARRETERA 846
Practice Address - Street 2:TRUJILLO MEDICAL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-961-0320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1305225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics