Provider Demographics
NPI:1952997710
Name:BETANCOURT ROSA, STEPHANIE A (OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:BETANCOURT ROSA
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 1:9726 VILLAS DE CIUDAD JARDIN APT C302
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-9847
Mailing Address - Country:US
Mailing Address - Phone:787-603-3373
Mailing Address - Fax:
Practice Address - Street 1:SER DE PUERTO RICO
Practice Address - Street 2:500 CALLE BAEZ
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-767-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1315225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty