Healthcare Provider Details

I. General information

NPI: 1205746070
Provider Name (Legal Business Name): IVELISSE TORRES OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 15 BOX 16280
HUMACAO PR
00791-9753
US

IV. Provider business mailing address

HC 15 BOX 16280
HUMACAO PR
00791-9753
US

V. Phone/Fax

Practice location:
  • Phone: 787-603-5470
  • Fax:
Mailing address:
  • Phone: 787-603-5470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number000968
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: