Healthcare Provider Details

I. General information

NPI: 1649452582
Provider Name (Legal Business Name): ADELINA RODRIGUEZ MARTINEZ OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 AVENIDA MUNOZ RIVERA
PONCE PR
00717-0643
US

IV. Provider business mailing address

1136 AVENIDA MUNOZ RIVERA
PONCE PR
00717-0643
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-7780
  • Fax:
Mailing address:
  • Phone: 787-840-7780
  • Fax: 787-840-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0269
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: