Provider Demographics
NPI:1932300209
Name:PERERA, KATHLEEN PATTERSON (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:PATTERSON
Last Name:PERERA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3923 STATION CT S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7608
Mailing Address - Country:US
Mailing Address - Phone:904-642-5320
Mailing Address - Fax:
Practice Address - Street 1:1422 SAN MARCO BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8536
Practice Address - Country:US
Practice Address - Phone:904-346-1720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 858225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist