Provider Demographics
NPI:1851309496
Name:PEROT, ELIZABETH (OT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PEROT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 CHAMA TRCE
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-5311
Mailing Address - Country:US
Mailing Address - Phone:512-497-4885
Mailing Address - Fax:512-894-2122
Practice Address - Street 1:485 CHAMA TRCE
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-5311
Practice Address - Country:US
Practice Address - Phone:512-497-4885
Practice Address - Fax:512-497-4885
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109894225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T6226OtherBLUE CROSS & BLUE SHIELD