Provider Demographics
NPI:1275168882
Name:VELEZ, ANTONIO (COTA)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:VELEZ
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 JACKMAN DR APT B
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-1220
Mailing Address - Country:US
Mailing Address - Phone:845-554-7342
Mailing Address - Fax:
Practice Address - Street 1:49 JACKMAN DR APT B
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-1220
Practice Address - Country:US
Practice Address - Phone:845-554-7342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010460224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant