MEDICARE: KRISTIAN NAGEL ORTIZ COLON OTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	1238	PR

General Provider Information

NPI Number	:	1124634324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIAN NAGEL ORTIZ COLON OTA

Provider Business Mailing Address
First Line	:	VILLA CAPRI VERONA 1180
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00924
Country	:	US
Telephone Number	:	787-615-2831
Fax Number	:

Provider Business Practice Location Address
First Line	:	VILLA CAPRI VERONA 1180
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00924
Country	:	US
Telephone Number	:	787-615-2831
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	09/22/2020

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