Healthcare Provider Details

I. General information

NPI: 1659688448
Provider Name (Legal Business Name): ASHLEY PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9508 GRIFFIN RD
COOPER CITY FL
33328-3416
US

IV. Provider business mailing address

2836 FILLMORE ST APT 35
HOLLYWOOD FL
33020-4261
US

V. Phone/Fax

Practice location:
  • Phone: 954-689-0730
  • Fax:
Mailing address:
  • Phone: 518-420-4739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number23191
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number007587-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number019733-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberP95913
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: