Provider Demographics
NPI:1275995151
Name:VELA, EDGAR (OTR)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:
Last Name:VELA
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 E FM 495
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-4666
Mailing Address - Country:US
Mailing Address - Phone:956-283-5499
Mailing Address - Fax:956-283-5310
Practice Address - Street 1:516 E FM 495
Practice Address - Street 2:SUITE B
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-4666
Practice Address - Country:US
Practice Address - Phone:956-283-5499
Practice Address - Fax:956-283-5310
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117554225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist