Provider Demographics
NPI:1861099962
Name:GROWING UP THERAPY AND RESEARCH CENTER
Entity type:Organization
Organization Name:GROWING UP THERAPY AND RESEARCH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPY ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIAN
Authorized Official - Middle Name:NAGEL
Authorized Official - Last Name:ORTIZ COLON
Authorized Official - Suffix:
Authorized Official - Credentials:OTA
Authorized Official - Phone:787-615-2831
Mailing Address - Street 1:322 CALLE BADAJOZ
Mailing Address - Street 2:VALENCIA SUITES A-1
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923
Mailing Address - Country:US
Mailing Address - Phone:787-318-1181
Mailing Address - Fax:
Practice Address - Street 1:322 CALLE BADAJOZ
Practice Address - Street 2:VALENCIA SUITES A-1
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-318-1181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty