Provider Demographics
NPI:1316381189
Name:PEREZ PELLOT, MAYTE ALEXANDRA (MOTR/L)
Entity Type:Individual
Prefix:
First Name:MAYTE
Middle Name:ALEXANDRA
Last Name:PEREZ PELLOT
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 S SEMORAN BLVD APT B
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2870
Mailing Address - Country:US
Mailing Address - Phone:407-221-9883
Mailing Address - Fax:
Practice Address - Street 1:1907 S SEMORAN BLVD
Practice Address - Street 2:APT B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822
Practice Address - Country:US
Practice Address - Phone:407-221-9883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15099225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist