Provider Demographics
NPI:1336353739
Name:AQUINO, VANESSA M (OTR)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:M
Last Name:AQUINO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BD1 CALLE DR PORMICEDO
Mailing Address - Street 2:5TA SEC. LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3434
Mailing Address - Country:US
Mailing Address - Phone:787-630-3717
Mailing Address - Fax:
Practice Address - Street 1:BD1 CALLE DR PORMICEDO
Practice Address - Street 2:5TA SEC. LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3434
Practice Address - Country:US
Practice Address - Phone:787-630-3717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR762225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist