Provider Demographics
NPI:1457408361
Name:VELA, TANYA KIMBALL (OTRL)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:KIMBALL
Last Name:VELA
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:WALDO
Mailing Address - State:OH
Mailing Address - Zip Code:43356-0195
Mailing Address - Country:US
Mailing Address - Phone:740-815-4222
Mailing Address - Fax:740-494-9201
Practice Address - Street 1:6084 LAUER RD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:OH
Practice Address - Zip Code:43342-9562
Practice Address - Country:US
Practice Address - Phone:740-815-4222
Practice Address - Fax:740-494-9201
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 002645225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist