Provider Demographics
NPI:1760602429
Name:VELDING, LINDA ANN (COTA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:VELDING
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 1:4440 FOGESON DR
Mailing Address - Street 2:
Mailing Address - City:CORAL
Mailing Address - State:MI
Mailing Address - Zip Code:49322-9780
Mailing Address - Country:US
Mailing Address - Phone:231-354-0012
Mailing Address - Fax:
Practice Address - Street 1:17615 W MOORE
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:MI
Practice Address - Zip Code:49327-9408
Practice Address - Country:US
Practice Address - Phone:231-834-0208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202002008224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236598Medicare ID - Type Unspecified