Provider Demographics
NPI:1861559767
Name:ACEVEDO-CASTRO, LUZ MINELBA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LUZ
Middle Name:MINELBA
Last Name:ACEVEDO-CASTRO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:LUZ
Other - Middle Name:MINELBA
Other - Last Name:MACHADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:734 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-3546
Mailing Address - Country:US
Mailing Address - Phone:310-710-4146
Mailing Address - Fax:
Practice Address - Street 1:734 JAMES ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3546
Practice Address - Country:US
Practice Address - Phone:310-710-4146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT6671225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist