Individual
JISELLE AMY VELAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
6715 LITTLE RIVER TPKE STE 200, ANNANDALE, VA 22003-3546
(703) 879-2479
Mailing address
2776 S ARLINGTON MILL DR # 534, ARLINGTON, VA 22206-3402
(703) 879-2479
(703) 879-2803
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
0119005607
VA
225XP0200X
Pediatric Occupational Therapist
Primary
0119005607
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
225XP0200X
OT
VA
Enumeration date
08/01/2012
Last updated
03/18/2021
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