Provider Demographics
NPI:1881835635
Name:MSL THERAPEUTICAL SERVICES, PSC
Entity type:Organization
Organization Name:MSL THERAPEUTICAL SERVICES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARICARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTANET AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:787-744-4828
Mailing Address - Street 1:PO BOX 4956
Mailing Address - Street 2:PMB 2105
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-4956
Mailing Address - Country:US
Mailing Address - Phone:787-594-1126
Mailing Address - Fax:787-744-6443
Practice Address - Street 1:B5 CALLE CORCHADO
Practice Address - Street 2:AVE JOSE VILLARES URB PARADIS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2622
Practice Address - Country:US
Practice Address - Phone:787-594-1126
Practice Address - Fax:787-744-6443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-08
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038888200Medicaid