Provider Demographics
NPI:1326650235
Name:PERRILLES, CHERYL ANNETTE
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANNETTE
Last Name:PERRILLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5124 S ALASKA RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61607-9541
Mailing Address - Country:US
Mailing Address - Phone:309-219-3631
Mailing Address - Fax:
Practice Address - Street 1:5124 S ALASKA RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61607-9541
Practice Address - Country:US
Practice Address - Phone:309-219-3631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057001346224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty