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General NPI Number Information
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NPI Number | 1306547047
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Entity Type | Individual
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Provider Name | SYLVIA IVELISSE BURGOS OTL
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Gender | Female
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Dates
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Enumeration Date | 03/10/2023
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Last Update Date | 03/10/2023
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Provider Practice Location Address
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Address Line | CARR. 845 INT. 199 KM 3 HM9 BARRIO LAS CUEVAS
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976-0097
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Country | US
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Telephone | 939-268-5223
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Fax |
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Provider Business Mailing Address
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Address Line | CARR. 845 INT. 199 KM 3 HM9 BARRIO LAS CUEVAS
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone | 939-268-5223
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 554
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License Number State | PR
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