Provider Demographics
NPI:1154016541
Name:VELAZQUEZ, MAKALEY M (COTA/L)
Entity type:Individual
Prefix:
First Name:MAKALEY
Middle Name:M
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28740 W THOME RD
Mailing Address - Street 2:
Mailing Address - City:ROCK FALLS
Mailing Address - State:IL
Mailing Address - Zip Code:61071-9263
Mailing Address - Country:US
Mailing Address - Phone:815-718-0918
Mailing Address - Fax:
Practice Address - Street 1:105 E 23RD ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-1212
Practice Address - Country:US
Practice Address - Phone:425-481-5626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098797224Z00000X
IL057.005885224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant