Provider Demographics
NPI:1164764114
Name:PERSEK, CAROLINE COOK (MA)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:COOK
Last Name:PERSEK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12651 CHRISTY LN
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-4939
Mailing Address - Country:US
Mailing Address - Phone:949-636-8660
Mailing Address - Fax:562-493-4542
Practice Address - Street 1:12651 CHRISTY LN
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-4939
Practice Address - Country:US
Practice Address - Phone:949-636-8660
Practice Address - Fax:562-493-4542
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-17
Last Update Date:2013-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3055225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist