Provider Demographics
NPI:1043541592
Name:CARRASQUILLO, CARMEN DORIS (OTL)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:DORIS
Last Name:CARRASQUILLO
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:URBANIZACION VILLAS DE SAN CRISTOBAL II
Mailing Address - Street 2:365 CALLE ILAN
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-9236
Mailing Address - Country:US
Mailing Address - Phone:787-453-6465
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA LUIS MUNOZ MARIN
Practice Address - Street 2:ANGORA PARK PLAZA LOCAL 2A
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-703-1971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR928225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics