Provider Demographics
NPI:1992981906
Name:ORTIZ-VICENTE, KENNETH W (OT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:W
Last Name:ORTIZ-VICENTE
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#139 C/LA BORINQUENA
Mailing Address - Street 2:URB. MANSIONES MONTE VERDE
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4154
Mailing Address - Country:US
Mailing Address - Phone:787-460-4671
Mailing Address - Fax:787-703-4343
Practice Address - Street 1:CALLE 28 T-1-4
Practice Address - Street 2:URB. TURABO GARDENS 2
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-460-4671
Practice Address - Fax:787-703-4343
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR799225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist