MEDICARE: STEPHANIE A BETANCOURT ROSA OTR/L

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	1315	PR

General Provider Information

NPI Number	:	1952997710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE A BETANCOURT ROSA OTR/L

Provider Business Mailing Address
First Line	:	9726 VILLAS DE CIUDAD JARDIN APT C302
Second Line	:
City	:	CANOVANAS
State	:	PR
Zip	:	00729-9847
Country	:	US
Telephone Number	:	787-603-3373
Fax Number	:

Provider Business Practice Location Address
First Line	:	SER DE PUERTO RICO
Second Line	:	500 CALLE BAEZ
City	:	SAN JUAN
State	:	PR
Zip	:	00917
Country	:	US
Telephone Number	:	787-767-6710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2020
Last Update Date	:	12/16/2020

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