Most Relevant Information
Provider Data
| NPI Number: | 1003555004 |
| Provider Name: | JARED VICTOR VIRELLA COTA/L |
| Entity Type: | Individual |
| Taxonomy Code: | 224Z00000X |
| Specialty: | Occupational Therapy Assistant |
| License Number: | 011108 |
Most Important Dates
| Enumeration Date: | 05/31/2022 |
| Last Updated: | 05/31/2022 |
Provider Practice Location
49 MONTROSE AVE
BROOKLYN
NY
112062580
Practice Location Phone/Fax
| Phone: | 7184733808 |
| Fax: |
Provider Mailing Location
511 W 232ND ST APT E43
BRONX
NY
104633561
Provider Mailing Phone/Fax
| Phone: | 6462218750 |
| Fax: |