Provider Demographics
NPI:1124445861
Name:PEREZ-ALBERT, CAMILA (OTR/L, DPT)
Entity type:Individual
Prefix:
First Name:CAMILA
Middle Name:
Last Name:PEREZ-ALBERT
Suffix:
Gender:F
Credentials:OTR/L, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE B2
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:290 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE B2
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8130
Practice Address - Country:US
Practice Address - Phone:386-898-0443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 15535225X00000X
FLPT29875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z06FBOtherBCBS
Z06FBOtherBCBS