Healthcare Provider Details

I. General information

NPI: 1396493177
Provider Name (Legal Business Name): VANESSA VAZQUEZ OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 COMMERCE ST
MILLBROOK AL
36054-4212
US

IV. Provider business mailing address

2050 COMMERCE ST
MILLBROOK AL
36054-4212
US

V. Phone/Fax

Practice location:
  • Phone: 334-290-5095
  • Fax:
Mailing address:
  • Phone: 334-290-5095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6973
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: