Individual
JOHALYS MARIE SANTIAGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
LAS VEGAS MALL LOCAL DD-2, VEGA BAJA, PR 00693
(787) 915-3000
Mailing address
PO BOX 140053, ARECIBO, PR 00614-0053
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2222-2
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6746664
DRIVERS LICENSE
PR
Enumeration date
02/13/2020
Last updated
02/13/2020
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