Healthcare Provider Details

I. General information

NPI: 1649181496
Provider Name (Legal Business Name): DESIREE VELEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 GRANT ST
EVANSTON IL
60201-1903
US

IV. Provider business mailing address

8970 N PARKSIDE AVE APT 402
DES PLAINES IL
60016-5514
US

V. Phone/Fax

Practice location:
  • Phone: 847-492-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: