Provider Demographics
NPI:1861588287
Name:MEDINA, LEGNA NOEMI (OTL)
Entity type:Individual
Prefix:MRS
First Name:LEGNA
Middle Name:NOEMI
Last Name:MEDINA
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:AVE. MAGNOLIA O-2
Mailing Address - Street 2:MAGNOLIA GARDENS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-0001
Mailing Address - Country:US
Mailing Address - Phone:787-995-6207
Mailing Address - Fax:787-730-8180
Practice Address - Street 1:CALLE JULIO ALVARADO 130
Practice Address - Street 2:URB FRONTERAS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-0001
Practice Address - Country:US
Practice Address - Phone:787-512-0288
Practice Address - Fax:787-730-8180
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR827225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0057442Medicare ID - Type Unspecified