Provider Demographics
NPI:1568441996
Name:PEREZ, CARMEN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:DUMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1480 W 68 ST. #101
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014
Mailing Address - Country:US
Mailing Address - Phone:305-818-2213
Mailing Address - Fax:305-817-8548
Practice Address - Street 1:1480 W 68 ST. #101
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014
Practice Address - Country:US
Practice Address - Phone:305-818-2213
Practice Address - Fax:305-817-8548
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8343225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103736000Medicaid
E4156Medicare ID - Type Unspecified