Provider Demographics
NPI:1700523966
Name:PEREZ, KATHY ANN (COTA)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 N SALINAS BLVD
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-2926
Mailing Address - Country:US
Mailing Address - Phone:956-464-1002
Mailing Address - Fax:
Practice Address - Street 1:128 N SALINAS BLVD
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-2926
Practice Address - Country:US
Practice Address - Phone:956-464-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208753224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty