Provider Demographics
NPI:1205963170
Name:PERLAK, CHRISTINA MARY (OTRL)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARY
Last Name:PERLAK
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PERVIER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-4402
Mailing Address - Country:US
Mailing Address - Phone:413-532-5404
Mailing Address - Fax:
Practice Address - Street 1:46 VINAL AVE
Practice Address - Street 2:#2
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1824
Practice Address - Country:US
Practice Address - Phone:413-478-7468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8301225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist