Healthcare Provider Details

I. General information

NPI: 1336023068
Provider Name (Legal Business Name): ELIZANETTE PERKINS OTD,OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEREDITH DR
DURHAM NC
27713-2681
US

IV. Provider business mailing address

3836 NC 55 HWY APT 1304
DURHAM NC
27713-2076
US

V. Phone/Fax

Practice location:
  • Phone: 919-361-1234
  • Fax:
Mailing address:
  • Phone: 860-629-9603
  • Fax: 860-629-9603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number17833
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: