Provider Demographics
NPI:1821510413
Name:CENTRO DE TERAPIA OCUPACIONAL PEDIATRICA DEL SURESTE LLC
Entity Type:Organization
Organization Name:CENTRO DE TERAPIA OCUPACIONAL PEDIATRICA DEL SURESTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASISTENTE DE TERAPIA OCUPACIONAL
Authorized Official - Prefix:
Authorized Official - First Name:BETHMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
Authorized Official - Phone:787-484-4168
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:MAUNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00707-0192
Mailing Address - Country:US
Mailing Address - Phone:787-484-4168
Mailing Address - Fax:
Practice Address - Street 1:AVE LOS VETERANOS CALLE 3
Practice Address - Street 2:GUAYAMA MEDICAL CENTER
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785
Practice Address - Country:US
Practice Address - Phone:787-484-4168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR807225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty