Provider Demographics
NPI:1730720293
Name:DIAZ VELEZ, TEISHA MARIE (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:TEISHA
Middle Name:MARIE
Last Name:DIAZ VELEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB VALLE TOLIMA
Mailing Address - Street 2:CALLE MANUEL PEREZ DURAN J-8
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-923-3070
Mailing Address - Fax:
Practice Address - Street 1:6 CALLE LUIS BARRERAS N
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-3734
Practice Address - Country:US
Practice Address - Phone:787-263-2736
Practice Address - Fax:787-263-2750
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001299225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty