Provider Demographics
NPI:1760983373
Name:RAYOS DEL SOL, MARK LANCEL TRESPALACIOREAL (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:MARK LANCEL
Middle Name:TRESPALACIOREAL
Last Name:RAYOS DEL SOL
Suffix:
Gender:M
Credentials:OTR/L
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Mailing Address - Street 1:28 SHARON DR
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3429
Mailing Address - Country:US
Mailing Address - Phone:973-842-1325
Mailing Address - Fax:973-842-1325
Practice Address - Street 1:787 NORTHFIELD AVE
Practice Address - Street 2:REHAB DEPT
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052
Practice Address - Country:US
Practice Address - Phone:973-731-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00623700225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation