=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922898832
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLORIA E. MEDINA VARGAS OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2025
-----------------------------------------------------
Last Update Date | 05/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1225 MARGINAL VILLAMAR
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00979-6345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-533-0923
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | COLINAS DE CUPEY B 59 CALLE 1
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926-7524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-409-6331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 593
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------