Provider Demographics
NPI:1679825319
Name:ROSARIO ABREU, MARLENE (OT/L)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:ROSARIO ABREU
Suffix:
Gender:F
Credentials:OT/L
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 1503
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-1503
Mailing Address - Country:US
Mailing Address - Phone:787-249-6036
Mailing Address - Fax:
Practice Address - Street 1:MARGINAL LOS ANGELES, URB. LOS ANGELES
Practice Address - Street 2:#2220
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00787
Practice Address - Country:US
Practice Address - Phone:787-239-9964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XM0800X, 225XP0019X
PR1146225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4484066OtherDRIVER'S LICENSE