Individual
MS. CONSTANCE DE LA VEGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
400 W 7TH ST, FREDERICK, MD 21701-4506
(240) 566-3337
(240) 566-4872
Mailing address
400 W 7TH ST, FREDERICK, MD 21701-4506
(240) 566-3337
(240) 566-4872
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
03565
MD
Other
Enumeration date
12/09/2010
Last updated
12/09/2010
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