Healthcare Provider Details

I. General information

NPI: 1972993368
Provider Name (Legal Business Name): MARIEL NUNEZ OTL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. ROBERTO CLEMENTE BLQ. 27 #2716
CAROLINA PR
00985
US

IV. Provider business mailing address

URB. LOS ARBOLES #55 C/ GUARAGUAO
RIO GRANDE PR
00745
US

V. Phone/Fax

Practice location:
  • Phone: 787-276-8123
  • Fax: 787-257-2179
Mailing address:
  • Phone: 787-391-9384
  • Fax: 787-257-2179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number941
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: