Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | OT1031 | FL |
Y | 225X00000X | Occupational Therapist | 3413 | SC |
N | 225XH1200X | Occupational Therapist - Hand | OT1031 | FL |
NPI | 1235249418 |
---|---|
Provider Name | Mr. Nelson Vazquez |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Seneca, SC 29678-4526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 18/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
889777800 | (05) | FL |