Provider Demographics
NPI:1396092490
Name:MAYES, GUILLERMO H (OTR/L)
Entity type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:H
Last Name:MAYES
Suffix:
Gender:M
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 1:2704 WALLACE AVE
Mailing Address - Street 2:APT 2 S
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8821
Mailing Address - Country:US
Mailing Address - Phone:347-647-1671
Mailing Address - Fax:
Practice Address - Street 1:2704 WALLACE AVE
Practice Address - Street 2:APT 2 S
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-8821
Practice Address - Country:US
Practice Address - Phone:347-647-1671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017460225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist