Healthcare Provider Details

I. General information

NPI: 1043464027
Provider Name (Legal Business Name): NOEL LEE VELARDE OT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 WRECKENRIDGE RD
FLINT MI
48532-3233
US

IV. Provider business mailing address

6360 WRECKENRIDGE RD
FLINT MI
48532-3233
US

V. Phone/Fax

Practice location:
  • Phone: 810-845-7224
  • Fax:
Mailing address:
  • Phone: 810-845-7224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT8200
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT8200
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: