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General NPI Number Information
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NPI Number | 1114880713
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Entity Type | Individual
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Provider Name | AVERY LUIS VAZQUEZ
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Gender | Male
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 682 PLEASANT DR
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City | WARREN
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State | PA
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Zip | 16365-3499
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Country | US
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Telephone | 814-723-7060
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Fax |
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Provider Business Mailing Address
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Address Line | 119 N SOUTH ST
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City | WARREN
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State | PA
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Zip | 16365-2762
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Country | US
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Telephone | 814-779-8502
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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