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General NPI Number Information
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NPI Number | 1801188594
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Entity Type | Individual
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Provider Name | ELIEZER VELASQUEZ COTA
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Gender | Male
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 1120 MORRIS PARK AVE. STE 2B THERAPEUTIC IMPRINTS, INC.
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City | BRONX
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State | NY
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Zip | 10461
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Country | US
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Telephone | 718-409-6977
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Fax | 718-409-6946
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Provider Business Mailing Address
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Address Line | 14445 35TH AVE APT. 2B
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City | FLUSHING
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State | NY
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Zip | 11354-3633
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Country | US
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Telephone | 718-961-7715
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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 |
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License Number State |
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