Individual
LILLIAN MARLENE VELASCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1600 W 24TH ST, PUEBLO, CO 81003-1411
(719) 546-4284
Mailing address
PO BOX 242, PENROSE, CO 81240-0242
(719) 429-1370
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
983809
NBCOT
CO
Enumeration date
03/16/2011
Last updated
03/16/2011
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