Provider Demographics
NPI:1295095941
Name:LEDEE-BAZAN, NIKIMA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:NIKIMA
Middle Name:
Last Name:LEDEE-BAZAN
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 3308
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-3308
Mailing Address - Country:US
Mailing Address - Phone:787-212-4456
Mailing Address - Fax:787-864-0954
Practice Address - Street 1:108 CALLE HOSTOS N
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-4348
Practice Address - Country:US
Practice Address - Phone:787-212-4456
Practice Address - Fax:787-864-0954
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR189225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist