Provider Demographics
NPI:1407669922
Name:MERCADO, MELANIE JANICE
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:JANICE
Last Name:MERCADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10098 CARR 484
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-9750
Mailing Address - Country:US
Mailing Address - Phone:787-628-2823
Mailing Address - Fax:
Practice Address - Street 1:AVE. MIITAR 3361 CARR #211.3 BO. ARENALES ALTO
Practice Address - Street 2:GLORIMAR VEGA
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-965-0297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1565224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant