Provider Demographics
NPI:1154774552
Name:MATIAS, AYRA (MS OTL)
Entity type:Individual
Prefix:
First Name:AYRA
Middle Name:
Last Name:MATIAS
Suffix:
Gender:F
Credentials:MS OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 CALLE JULIAN BENGOCHEA
Mailing Address - Street 2:URBANIZACION SAN MARTIN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-200-0567
Mailing Address - Fax:
Practice Address - Street 1:1232 JULIAN BENGOCHEA
Practice Address - Street 2:URBANIZACION SAN MARTIN CALLE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-200-0567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1226225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist