Provider Demographics
NPI:1326280637
Name:PEREA, IRIS JEANNETTE (COTA)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:JEANNETTE
Last Name:PEREA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6510
Mailing Address - Country:US
Mailing Address - Phone:603-222-0300
Mailing Address - Fax:603-623-0917
Practice Address - Street 1:25 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6510
Practice Address - Country:US
Practice Address - Phone:603-222-0300
Practice Address - Fax:603-623-0917
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0562224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant