Provider Demographics
NPI:1558534669
Name:PERKOWSKI, MARY (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:PERKOWSKI
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 N 76TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-1074
Mailing Address - Country:US
Mailing Address - Phone:414-357-5105
Mailing Address - Fax:414-357-0604
Practice Address - Street 1:9301 N 76TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-1074
Practice Address - Country:US
Practice Address - Phone:414-357-5105
Practice Address - Fax:414-357-0604
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2541-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist