Provider Demographics
NPI:1003056060
Name:COLON RODRIGUEZ, MIRELY (OTR/L)
Entity type:Individual
Prefix:
First Name:MIRELY
Middle Name:
Last Name:COLON RODRIGUEZ
Suffix:
Gender:F
Credentials:OTR/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 188
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:PR
Mailing Address - Zip Code:00786-0188
Mailing Address - Country:US
Mailing Address - Phone:787-484-1268
Mailing Address - Fax:787-735-1991
Practice Address - Street 1:CALLE LUIS BARRERA EDIFICIO #6
Practice Address - Street 2:CENTRO FISIATRICO DE PLATA
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-263-2730
Practice Address - Fax:787-263-2750
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR892225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist