Healthcare Provider Details

I. General information

NPI: 1255303467
Provider Name (Legal Business Name): OT CLINICAL GROUP CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SS3 CALLE 35 URB. SANTA JUANITA
BAYAMON PR
00956-4748
US

IV. Provider business mailing address

SS3 CALLE 35 URB. SANTA JUANITA
BAYAMON PR
00956-4748
US

V. Phone/Fax

Practice location:
  • Phone: 787-785-9683
  • Fax: 787-785-9683
Mailing address:
  • Phone: 787-785-9683
  • Fax: 787-785-9683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number422
License Number StatePR

VIII. Authorized Official

Name: MRS. DORIS VEGA VILLAVICENCIO
Title or Position: PRESIDENTA
Credential: MPH,OTR/L
Phone: 787-785-9683