Provider Demographics
NPI:1235509985
Name:VELASQUEZ, NATALIE MICHELLE (MS OTR)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:MICHELLE
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6228 W IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219-3044
Mailing Address - Country:US
Mailing Address - Phone:414-322-6109
Mailing Address - Fax:
Practice Address - Street 1:6228 W IDAHO ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53219-3044
Practice Address - Country:US
Practice Address - Phone:414-322-6109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5712-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist