Provider Demographics
NPI:1609497619
Name:VASQUEZ ALVARADO, KLEVER MOISES (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:KLEVER
Middle Name:MOISES
Last Name:VASQUEZ ALVARADO
Suffix:
Gender:M
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 1:11112 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2620
Mailing Address - Country:US
Mailing Address - Phone:347-610-6297
Mailing Address - Fax:
Practice Address - Street 1:11112 42ND AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2620
Practice Address - Country:US
Practice Address - Phone:347-610-6297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024714225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist