Provider Demographics
NPI:1750620340
Name:VAZQUEZ, EVELYN (OTR)
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:VAZQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:10019 CHORLTON CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6167
Mailing Address - Country:US
Mailing Address - Phone:407-748-2444
Mailing Address - Fax:
Practice Address - Street 1:10019 CHORLTON CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6167
Practice Address - Country:US
Practice Address - Phone:407-748-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-03
Last Update Date:2013-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3204225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist