Provider Demographics
NPI:1124827746
Name:PEREZ, ALLYSON NICOLE (COTA)
Entity type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:NICOLE
Last Name:PEREZ
Suffix:
Gender:
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 AMITY LN
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-5611
Mailing Address - Country:US
Mailing Address - Phone:580-309-2262
Mailing Address - Fax:
Practice Address - Street 1:200 S RANCHWOOD BLVD STE 17
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-2743
Practice Address - Country:US
Practice Address - Phone:405-694-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2706224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant