Provider Demographics
NPI:1891907739
Name:PEROMSIK, JANIS RAEYELLIN (OTR-L)
Entity Type:Individual
Prefix:MRS
First Name:JANIS
Middle Name:RAEYELLIN
Last Name:PEROMSIK
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HADWEN RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-2938
Mailing Address - Country:US
Mailing Address - Phone:508-753-6781
Mailing Address - Fax:
Practice Address - Street 1:214 LAKE ST
Practice Address - Street 2:CHILD DEVELOPMENT CENTER
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3960
Practice Address - Country:US
Practice Address - Phone:508-856-4202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3144225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics