Provider Demographics
NPI:1821344433
Name:VELAZQUEZ, JISELLE AMY (OTR/L)
Entity Type:Individual
Prefix:
First Name:JISELLE
Middle Name:AMY
Last Name:VELAZQUEZ
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 1:2776 S ARLINGTON MILL DR # 534
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-3402
Mailing Address - Country:US
Mailing Address - Phone:703-879-2479
Mailing Address - Fax:703-879-2803
Practice Address - Street 1:6715 LITTLE RIVER TPKE STE 200
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3546
Practice Address - Country:US
Practice Address - Phone:703-879-2479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005607172V00000X
0119005607225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA225XP0200XOtherOT