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General NPI Number Information
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NPI Number | 1154016541
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Entity Type | Individual
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Provider Name | MAKALEY M VELAZQUEZ COTA/L
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Gender | Female
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 105 E 23RD ST
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City | STERLING
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State | IL
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Zip | 61081-1212
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Country | US
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Telephone | 425-481-5626
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Fax |
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Provider Business Mailing Address
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Address Line | 28740 W THOME RD
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City | ROCK FALLS
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State | IL
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Zip | 61071-9263
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Country | US
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Telephone | 815-718-0918
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 098797
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 057.005885
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License Number State | IL
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