Provider Demographics
NPI:1487887410
Name:MORALES, MIRAIDA AYMEE (OTL)
Entity type:Individual
Prefix:MRS
First Name:MIRAIDA
Middle Name:AYMEE
Last Name:MORALES
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B #70 STREET
Mailing Address - Street 2:RIO GRANDE HILLS
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:US
Mailing Address - Phone:787-206-4636
Mailing Address - Fax:
Practice Address - Street 1:B #70 STREET
Practice Address - Street 2:RIO GRANDE HILLS
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-206-4636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR803225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist