Provider Demographics
NPI:1588929178
Name:VELAZQUEZ, YESSENIA (OTL, MHC)
Entity type:Individual
Prefix:MRS
First Name:YESSENIA
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:OTL, MHC
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 659
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-0659
Mailing Address - Country:US
Mailing Address - Phone:787-562-1993
Mailing Address - Fax:
Practice Address - Street 1:ST. 111 ISAAC GONZALEZ Y LEDESMA
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641
Practice Address - Country:US
Practice Address - Phone:787-933-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2584101YM0800X
PR948225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health