Provider Demographics
NPI:1457542433
Name:VEGA RIVERA, AZALEA L (OTR/L)
Entity Type:Individual
Prefix:
First Name:AZALEA
Middle Name:L
Last Name:VEGA RIVERA
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 612
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-0612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BO. SUD VALLES DE CIDRA
Practice Address - Street 2:CARR. 171
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-0612
Practice Address - Country:US
Practice Address - Phone:787-739-3061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR949225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist