Provider Demographics
NPI:1164581229
Name:PERKINS, MARIAH (OTRL)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:NY
Mailing Address - Zip Code:14414-1006
Mailing Address - Country:US
Mailing Address - Phone:585-924-3642
Mailing Address - Fax:585-742-2559
Practice Address - Street 1:1235 STATE ROUTE 332
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NY
Practice Address - Zip Code:14425-1077
Practice Address - Country:US
Practice Address - Phone:585-924-3642
Practice Address - Fax:585-742-2559
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010935-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist