Healthcare Provider Details

I. General information

NPI: 1245895978
Provider Name (Legal Business Name): CARMEN ALICIA FERMAINT OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C10 CALLE OLAS URB PORTO FINO
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 142004
ARECIBO PR
00614-2004
US

V. Phone/Fax

Practice location:
  • Phone: 787-481-1838
  • Fax:
Mailing address:
  • Phone: 787-481-1838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0638
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number0638
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number0638
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number0638
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number0638
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: