Provider Demographics
NPI:1538641261
Name:VELASQUEZ, REBECCA (COTA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3728 S US HIGHWAY 287
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75109-8960
Mailing Address - Country:US
Mailing Address - Phone:903-874-6315
Mailing Address - Fax:903-874-6387
Practice Address - Street 1:3728 S US HIGHWAY 287
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75109-8960
Practice Address - Country:US
Practice Address - Phone:903-874-6315
Practice Address - Fax:903-874-6387
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212290224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant