Healthcare Provider Details

I. General information

NPI: 1922445360
Provider Name (Legal Business Name): CARLOS CARLE OCCUPATIONAL THERAPI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE FLAMBOYAN # 1187 PRATP JARDIN BOTANICO SUR
SAN JUAN PR
00926-1117
US

IV. Provider business mailing address

100 AVE HOSTOS A 32
BAYAMON PR
00956-5153
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-6035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number543
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: