MEDICARE: RESTAURA THERAPY SERVICES

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	225X00000X	Occupational Therapist	896	PR

General Provider Information

NPI Number	:	1821411042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTAURA THERAPY SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 191733
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00919-1733
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 DE DIEGO AVE STE 502
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00909-1758
Country	:	US
Telephone Number	:	787-598-7405
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTIAN DAVID IRIZARRY
Credential	:
Telephone Number	:	787-598-7405

Provider Enumeration Date	:	01/23/2014
Last Update Date	:	01/23/2014

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Directions to “RESTAURA THERAPY SERVICES ” Practice Location

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