Provider Demographics
NPI:1497141964
Name:VELASQUEZ, RENATA M (CERTIFIED OTA)
Entity type:Individual
Prefix:
First Name:RENATA
Middle Name:M
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:CERTIFIED OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5355 HENRY HUDSON PKWY W
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2830
Mailing Address - Country:US
Mailing Address - Phone:646-918-0039
Mailing Address - Fax:
Practice Address - Street 1:5355 HENRY HUDSON PKWY W
Practice Address - Street 2:SUITE 2F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2830
Practice Address - Country:US
Practice Address - Phone:646-918-0039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-12
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008501-1224Z00000X
FLOTA 14945224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTA 14945OtherFLORIDA STATE DEPARTMENT OF HEALTH
NY008501OtherNEW YORK STATE DEPARTMENT OF EDUCATION