Provider Demographics
NPI:1114118734
Name:PERALTA, DENISE CHRYSTINE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:CHRYSTINE
Last Name:PERALTA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:CHRYS
Other - Middle Name:
Other - Last Name:PERALTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:799 W BOYLSTON ST
Mailing Address - Street 2:MAB COMMUNITY SERVICES
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-3071
Mailing Address - Country:US
Mailing Address - Phone:508-854-0700
Mailing Address - Fax:
Practice Address - Street 1:799 W BOYLSTON ST
Practice Address - Street 2:MAB COMMUNITY SERVICES
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-3071
Practice Address - Country:US
Practice Address - Phone:508-854-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4105225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision