Provider Demographics
NPI:1043752140
Name:PERO, CHARITY JANE (COTA/L)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:JANE
Last Name:PERO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 N CENTRAL AVE
Mailing Address - Street 2:3
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3933
Mailing Address - Country:US
Mailing Address - Phone:310-463-5277
Mailing Address - Fax:
Practice Address - Street 1:4301 N CENTRAL AVE
Practice Address - Street 2:3
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3933
Practice Address - Country:US
Practice Address - Phone:310-463-5277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 14538224Z00000X
COOTA.0000770224Z00000X
OR343323224Z00000X
TX214213224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant