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General NPI Number Information
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NPI Number | 1164764114
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Entity Type | Individual
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Provider Name | CAROLINE COOK PERSEK MA
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Gender | Female
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Dates
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Enumeration Date | 03/17/2013
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Last Update Date | 03/17/2013
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Provider Practice Location Address
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Address Line | 12651 CHRISTY LN
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-4939
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Country | US
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Telephone | 949-636-8660
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Fax | 562-493-4542
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Provider Business Mailing Address
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Address Line | 12651 CHRISTY LN
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-4939
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Country | US
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Telephone | 949-636-8660
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Fax | 562-493-4542
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 3055
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License Number State | CA
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