Provider Demographics
NPI:1912504580
Name:DIAZ, NATHALY A. SCHELMETTY (OTA)
Entity type:Individual
Prefix:
First Name:NATHALY A.
Middle Name:SCHELMETTY
Last Name:DIAZ
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BRISAS DE TORTUGUERO
Mailing Address - Street 2:CALLE RIO BAIROA #32
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-324-0702
Mailing Address - Fax:
Practice Address - Street 1:BRISAS DE TORTUGUERO
Practice Address - Street 2:CALLE RIO BAIROA #32
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-324-0702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X
PR2258-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty