Provider Demographics
NPI:1659619930
Name:PEREZ, LUIS E SR (OTL)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:E
Last Name:PEREZ
Suffix:SR
Gender:M
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 44268
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-6216
Mailing Address - Country:US
Mailing Address - Phone:787-375-7868
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 44268
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-6216
Practice Address - Country:US
Practice Address - Phone:787-375-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR784225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR784OtherOCCUPATIONAL THERAPIST LICENSE