Provider Demographics
NPI:1225458060
Name:PEROSE, EMILY ELIZABETH (COTA/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ELIZABETH
Last Name:PEROSE
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 1:760 TROUT CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-4963
Mailing Address - Country:US
Mailing Address - Phone:610-984-4521
Mailing Address - Fax:
Practice Address - Street 1:760 TROUT CREEK LN
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-4963
Practice Address - Country:US
Practice Address - Phone:610-984-4521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-20
Last Update Date:2014-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006774224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant