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NPI Code Detail

MEDICARE: ASHLEY NICOLE VELEZ MARIN

MEDICARE: ASHLEY NICOLE VELEZ MARIN
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1679220743
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY NICOLE VELEZ MARIN
Provider Business Mailing Address
First Line : 75 LOGANBERRY LN NE
Second Line :
City : LUDOWICI
State : GA
Zip : 31316-3470
Country : US
Telephone Number : 912-980-3223
Fax Number :
Provider Business Practice Location Address
First Line : 506 N MAIN ST
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-2512
Country : US
Telephone Number : 615-560-6622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2022
Last Update Date : 11/13/2024

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Directions to “ ASHLEY NICOLE VELEZ MARIN ” Practice Location

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