Provider Demographics
NPI:1316123524
Name:LUGO, VANESSA (OT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:LUGO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 31609
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-9795
Mailing Address - Country:US
Mailing Address - Phone:787-375-8317
Mailing Address - Fax:
Practice Address - Street 1:STREET #129 SECTOR BUENOS AIRES
Practice Address - Street 2:CILICA DE TERAPIAS PASITOS DEL SABER
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:939-630-0319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR776225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist