Healthcare Provider Details

I. General information

NPI: 1821867664
Provider Name (Legal Business Name): HEATHER LISA PERONI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 VETERANS WAY
ORLANDO FL
32827-7401
US

IV. Provider business mailing address

4641 KATY DR
NEW SMYRNA BEACH FL
32169-4305
US

V. Phone/Fax

Practice location:
  • Phone: 407-599-1404
  • Fax:
Mailing address:
  • Phone: 917-699-5457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT16361
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: