Healthcare Provider Details

I. General information

NPI: 1154156792
Provider Name (Legal Business Name): SALLY PEREZ OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 SPRUCE AVE
WILMINGTON DE
19805-2148
US

IV. Provider business mailing address

1502 SPRUCE AVE
WILMINGTON DE
19805-2148
US

V. Phone/Fax

Practice location:
  • Phone: 302-552-3700
  • Fax:
Mailing address:
  • Phone: 302-552-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberU1-0012667
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: