Provider Demographics
NPI:1972178663
Name:VELASCO, SIERRA R (COTA)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:R
Last Name:VELASCO
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 1:921 W SANGER ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-4917
Mailing Address - Country:US
Mailing Address - Phone:575-433-2002
Mailing Address - Fax:888-729-4956
Practice Address - Street 1:921 W SANGER ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-4917
Practice Address - Country:US
Practice Address - Phone:575-433-2002
Practice Address - Fax:888-729-4956
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOT3834224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMOT3834OtherSTATE LICENSE