Healthcare Provider Details

I. General information

NPI: 1861630485
Provider Name (Legal Business Name): HEYDI COLON ALICEA OTL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 05/09/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 AVE AVELINO VICENTE
SAN JUAN PR
00909-2538
US

IV. Provider business mailing address

25 CALLE CORONEL IRIZARRY URB SAN MARTIN
CAYEY PR
00736-3304
US

V. Phone/Fax

Practice location:
  • Phone: 787-303-9662
  • Fax:
Mailing address:
  • Phone: 787-975-9891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number743
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: