Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 056006489 | IL |
Y | 225XH1200X | Occupational Therapist - Hand | 056-006489 | IL |
NPI | 1043276702 |
---|---|
Provider Name | Mrs. Marlene B Perez |
First Address | Palos Park, IL 60464-3047 |
Second Address | Palos Hills, IL 60465-1971 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 07/05/2013 |