Provider Demographics
NPI:1851436620
Name:VAZQUEZ, ANA M (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:M
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 SHERMAN CT
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1830
Mailing Address - Country:US
Mailing Address - Phone:646-591-1054
Mailing Address - Fax:
Practice Address - Street 1:2951 SHERMAN CT
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1830
Practice Address - Country:US
Practice Address - Phone:646-591-1054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5271-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist