Provider Demographics
NPI:1922491208
Name:OLIVERAS SANTIAGO, MARTA
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:OLIVERAS SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 AVE VICENTE
Mailing Address - Street 2:
Mailing Address - City:SANTURCE
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00909
Mailing Address - Country:UM
Mailing Address - Phone:787-303-9662
Mailing Address - Fax:787-724-5559
Practice Address - Street 1:759 AVE AVELINO VICENTE
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-2538
Practice Address - Country:US
Practice Address - Phone:787-303-9662
Practice Address - Fax:787-724-5559
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1862-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant