Provider Demographics
NPI:1952161689
Name:ACEVEDO, NOELLE RENEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:RENEE
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3338 GLADE CREEK BLVD NE APT 11
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-8645
Mailing Address - Country:US
Mailing Address - Phone:276-389-4311
Mailing Address - Fax:
Practice Address - Street 1:1110 VINYARD RD
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-3632
Practice Address - Country:US
Practice Address - Phone:276-389-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119009898225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist