Provider Demographics
NPI:1508423112
Name:PEREZ, MARI ALICIA (MOTR/L)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:ALICIA
Last Name:PEREZ
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 1:7008 CALLE ALMERIA NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1095
Mailing Address - Country:US
Mailing Address - Phone:575-494-6472
Mailing Address - Fax:
Practice Address - Street 1:8820 HORIZON BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1689
Practice Address - Country:US
Practice Address - Phone:505-998-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOT3737225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist