Provider Demographics
NPI:1760264105
Name:PERALTA, OLIVIA CHASE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:CHASE
Last Name:PERALTA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:305 S SWEET GUM PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-4502
Mailing Address - Country:US
Mailing Address - Phone:918-629-5508
Mailing Address - Fax:
Practice Address - Street 1:4619 S HARVARD AVE STE 102
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2944
Practice Address - Country:US
Practice Address - Phone:539-867-3151
Practice Address - Fax:918-513-5808
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK5849225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics