Provider Demographics
NPI:1033679121
Name:AZIEGBE, VALERIE OMOLEFE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:OMOLEFE
Last Name:AZIEGBE
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 1:86 FLEET PL APT 21E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-7156
Mailing Address - Country:US
Mailing Address - Phone:540-424-4582
Mailing Address - Fax:
Practice Address - Street 1:2118 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2347
Practice Address - Country:US
Practice Address - Phone:540-424-4582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023445225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0023445OtherSTATE LICENSE