Individual
KELLY QUEZADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
904 MOUNTAINSIDE DR, SOUTHFIELDS, NY 10975-2632
(845) 351-5551
(845) 564-6974
Mailing address
904 MOUNTAINSIDE DR, SOUTHFIELDS, NY 10975-2632
(845) 351-5551
(845) 564-6974
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
004529-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004529-1
COTA LICENSE
NY
Enumeration date
02/13/2007
Last updated
07/08/2007
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