MEDICARE: LUIS A. MORALES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	835	PR
2	225000000X	Orthotic Fitter	C22023	PR

General Provider Information

NPI Number	:	1598829244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUIS A. MORALES

Provider Business Mailing Address
First Line	:	3178 CALLE CRESTA
Second Line	:
City	:	TOA BAJA
State	:	PR
Zip	:	00949-3130
Country	:	US
Telephone Number	:	787-261-1298
Fax Number	:

Provider Business Practice Location Address
First Line	:	3178 CALLE CRESTA
Second Line	:
City	:	TOA BAJA
State	:	PR
Zip	:	00949-3130
Country	:	US
Telephone Number	:	787-261-1298
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MRS. LORNA TORRES
Credential	:	OT
Telephone Number	:	787-261-1298

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	06/25/2013

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