Provider Demographics
NPI:1265178321
Name:VASQUEZ, ALICIA MARCIANA (COTA)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARCIANA
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:MARCIANA
Other - Last Name:AMADOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3745 WOODWORTH DR
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-6100
Mailing Address - Country:US
Mailing Address - Phone:440-989-6094
Mailing Address - Fax:
Practice Address - Street 1:3745 WOODWORTH DR
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-6100
Practice Address - Country:US
Practice Address - Phone:440-989-6094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA006867224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant