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General NPI Number Information
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NPI Number | 1861588287
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Entity Type | Individual
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Provider Name | LEGNA NOEMI MEDINA OTL
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | CALLE JULIO ALVARADO 130 URB FRONTERAS
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City | BAYAMON
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State | PR
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Zip | 00961-0001
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Country | US
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Telephone | 787-512-0288
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Fax | 787-730-8180
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Provider Business Mailing Address
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Address Line | AVE. MAGNOLIA O-2 MAGNOLIA GARDENS
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City | BAYAMON
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State | PR
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Zip | 00956-0001
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Country | US
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Telephone | 787-995-6207
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Fax | 787-730-8180
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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 | 827
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License Number State | PR
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