Provider Demographics
NPI:1518360742
Name:PERONO, WILBUR JAGORILES
Entity Type:Individual
Prefix:
First Name:WILBUR
Middle Name:JAGORILES
Last Name:PERONO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 RICHARD BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4387
Mailing Address - Country:US
Mailing Address - Phone:203-400-1372
Mailing Address - Fax:
Practice Address - Street 1:99 RICHARD BLVD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4387
Practice Address - Country:US
Practice Address - Phone:203-400-1372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3217225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist