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General NPI Number Information
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NPI Number | 1588792717
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Entity Type | Individual
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Provider Name | MELESANDE MARIE PERERA MS OTR
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Gender | Female
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8190 W DEER VALLEY RD STE 104-200
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City | PEORIA
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State | AZ
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Zip | 85382-2126
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Country | US
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Telephone | 269-267-1210
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Fax |
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Provider Business Mailing Address
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Address Line | 16356 N THOMPSON PEAK PKWY APT 1033N
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-2130
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Country | US
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Telephone | 269-267-1210
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Fax |
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 3746
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License Number State | AZ
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