Provider Demographics
NPI:1568006484
Name:RESTREPO, VICTORIA ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:ELIZABETH
Last Name:RESTREPO
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 1:50 HEMLOCK LN
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-3918
Mailing Address - Country:US
Mailing Address - Phone:516-592-0865
Mailing Address - Fax:
Practice Address - Street 1:50 HEMLOCK LN
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-3918
Practice Address - Country:US
Practice Address - Phone:516-592-0865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024174225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY024174OtherLICENSE NUMBER