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General NPI Number Information
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NPI Number | 1518225846
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Entity Type | Individual
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Provider Name | JULISSA MARIA VELEZ TAVERAS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 1851 GOLDEN EAGLE WAY STE 43
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-4334
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Country | US
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Telephone | 904-736-3470
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Fax |
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Provider Business Mailing Address
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Address Line | 1132 MCKINLEY CT
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City | JACKSONVILLE
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State | FL
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Zip | 32205-7947
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Country | US
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Telephone |
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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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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 017376
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 15898
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License Number State | FL
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