Provider Demographics
NPI:1306547047
Name:BURGOS, SYLVIA IVELISSE (OTL)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:IVELISSE
Last Name:BURGOS
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR. 845 INT. 199 KM 3 HM9 BARRIO LAS CUEVAS
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:939-268-5223
Mailing Address - Fax:
Practice Address - Street 1:CARR. 845 INT. 199 KM 3 HM9 BARRIO LAS CUEVAS
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-0097
Practice Address - Country:US
Practice Address - Phone:939-268-5223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR554225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist