MEDICARE: NICOLE MICHELLE PEREZ OTR/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	12758	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558532168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MICHELLE PEREZ OTR/L

Provider Business Mailing Address
First Line	:	1004 RUTH JORDANA CT
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-3250
Country	:	US
Telephone Number	:	407-242-1431
Fax Number	:

Provider Business Practice Location Address
First Line	:	20345 MAJESTIC ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32833-3828
Country	:	US
Telephone Number	:	305-794-5063
Fax Number	:

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

Provider Enumeration Date	:	03/23/2008
Last Update Date	:	03/15/2024

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