Provider Demographics
NPI:1376956060
Name:PEREZ, JANELLE MARIE (COTA)
Entity Type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:MARIE
Last Name:PEREZ
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 1:177 LAKE CARNEGIE CT
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2062
Mailing Address - Country:US
Mailing Address - Phone:956-764-0155
Mailing Address - Fax:
Practice Address - Street 1:1505 CALLE DEL NORTE
Practice Address - Street 2:#440
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6036
Practice Address - Country:US
Practice Address - Phone:956-722-6221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210833224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant