Provider Demographics
NPI:1831213974
Name:ADAME-SANTIAGO, MARILYN M
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:M
Last Name:ADAME-SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:M
Other - Last Name:ADAMES-SANTIAGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:CAMINO DE LA VEREDA #154
Mailing Address - Street 2:ESTANCIAS DE JUNCOS
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-9778
Mailing Address - Country:US
Mailing Address - Phone:787-925-7033
Mailing Address - Fax:
Practice Address - Street 1:154 DE LA VEREDA ST.
Practice Address - Street 2:ESTANCIAS DE JUNCOS
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-9778
Practice Address - Country:US
Practice Address - Phone:787-925-7033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1106225100000X
PR732235Z00000X
FLSA 8445235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1106OtherLICENCE NUMBER