Provider Demographics
NPI:1396292082
Name:AVILES, IDY (OTL 636)
Entity type:Individual
Prefix:
First Name:IDY
Middle Name:
Last Name:AVILES
Suffix:
Gender:F
Credentials:OTL 636
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 873
Mailing Address - Street 2:
Mailing Address - City:SABANA HOYOS
Mailing Address - State:PR
Mailing Address - Zip Code:00688-0873
Mailing Address - Country:US
Mailing Address - Phone:787-503-9520
Mailing Address - Fax:
Practice Address - Street 1:50 CARR 639 UNIT 873
Practice Address - Street 2:
Practice Address - City:SABANA HOYOS
Practice Address - State:PR
Practice Address - Zip Code:00688-6842
Practice Address - Country:US
Practice Address - Phone:787-503-9520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR636225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist