Provider Demographics
NPI:1952581498
Name:SANTACROCE-VELARDE, PAULA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:
Last Name:SANTACROCE-VELARDE
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 1:2505 OSAGE PL
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-3000
Mailing Address - Country:US
Mailing Address - Phone:919-294-4363
Mailing Address - Fax:
Practice Address - Street 1:2505 OSAGE PL
Practice Address - Street 2:SEAFORD
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-3000
Practice Address - Country:US
Practice Address - Phone:919-294-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006728-1225X00000X
NC006728-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist