Provider Demographics
NPI:1952039430
Name:MILLS FEBO, DORIAN JULISSA (OTL)
Entity Type:Individual
Prefix:
First Name:DORIAN
Middle Name:JULISSA
Last Name:MILLS FEBO
Suffix:
Gender:F
Credentials:OTL
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 622
Mailing Address - Street 2:
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718-0622
Mailing Address - Country:US
Mailing Address - Phone:787-241-5900
Mailing Address - Fax:
Practice Address - Street 1:URB. EL RECREO CALLE RAFAEL ROSARIO ARROYO #46
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-373-8883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1325225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist