Provider Demographics
NPI:1396115762
Name:VASQUEZ, VANESSA (OT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 LINTON BLVD
Mailing Address - Street 2:BLDG 201-A
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6584
Mailing Address - Country:US
Mailing Address - Phone:561-496-6622
Mailing Address - Fax:561-496-6577
Practice Address - Street 1:4800 LINTON BLVD
Practice Address - Street 2:BLDG 201-A
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6584
Practice Address - Country:US
Practice Address - Phone:561-496-6622
Practice Address - Fax:561-496-6577
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT16230174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist