Healthcare Provider Details

I. General information

NPI: 1215994629
Provider Name (Legal Business Name): ANNETTE VALLE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 PASEO DEL VETERANO
PONCE PR
00716-2001
US

IV. Provider business mailing address

142 CALLE REINA ALEXANDRA MANS EN PASEO DE REYES
JUANA DIAZ PR
00795-4016
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax:
Mailing address:
  • Phone: 787-585-4735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number750
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number750
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: