Provider Demographics
NPI:1336773027
Name:VELIN, DERRY
Entity Type:Individual
Prefix:
First Name:DERRY
Middle Name:
Last Name:VELIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 HILLTOP DR # 4016
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0511
Mailing Address - Country:US
Mailing Address - Phone:530-604-0988
Mailing Address - Fax:
Practice Address - Street 1:3550 CHURN CREEK RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2718
Practice Address - Country:US
Practice Address - Phone:530-222-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA224Z00000XOtherOCCUPATIONAL THERAPY - REHABILITATIVE