Provider Demographics
NPI:1376678912
Name:PEREZ, JENNIFER JUNE (OT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JUNE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 FAYETTEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-3655
Mailing Address - Country:US
Mailing Address - Phone:479-632-4600
Mailing Address - Fax:
Practice Address - Street 1:344 FAYETTEVILLE AVE
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-3655
Practice Address - Country:US
Practice Address - Phone:479-632-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004234225X00000X
AROTR693225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO477602502Medicaid