MEDICARE: VICTOR MANUEL QUEVEDO OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	120417	TX

General Provider Information

NPI Number	:	1518599083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR MANUEL QUEVEDO OT

Provider Business Mailing Address
First Line	:	4207 GARDENDALE ST STE 104B
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4207 GARDENDALE ST STE 104B
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3142
Country	:	US
Telephone Number	:	210-582-5840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2020
Last Update Date	:	02/12/2020

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Directions to “ VICTOR MANUEL QUEVEDO OT” Practice Location

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