MEDICARE: JOANNA LYNN PEREZ OT/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	3436	CT

General Provider Information

NPI Number	:	1073371118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA LYNN PEREZ OT/L

Provider Business Mailing Address
First Line	:	55E STATE ST
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-2206
Country	:	US
Telephone Number	:	908-391-7719
Fax Number	:

Provider Business Practice Location Address
First Line	:	55E STATE ST
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-2206
Country	:	US
Telephone Number	:	908-391-7719
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2024
Last Update Date	:	03/12/2024

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