Healthcare Provider Details

I. General information

NPI: 1114233087
Provider Name (Legal Business Name): JAMIE PERO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2010
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 W HORIZON RIDGE PKWY SUITE 40
HENDERSON NV
89052-3995
US

IV. Provider business mailing address

133 SERENADE CT
HENDERSON NV
89074-0972
US

V. Phone/Fax

Practice location:
  • Phone: 702-564-4116
  • Fax:
Mailing address:
  • Phone: 734-223-5264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10-0047
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number10-0047
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: