Provider Demographics
NPI:1902017866
Name:IRIZARRY RODRIGUEZ, MAYRA I (OT)
Entity Type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:
Last Name:IRIZARRY RODRIGUEZ
Suffix:I
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:JOSE MERCADO
Mailing Address - Street 2:TOMAS JEFF U35
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-0000
Mailing Address - Country:US
Mailing Address - Phone:787-914-0417
Mailing Address - Fax:
Practice Address - Street 1:JOSE MERCADO
Practice Address - Street 2:TOMAS JEFF U35
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-0000
Practice Address - Country:US
Practice Address - Phone:787-914-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1060225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist