Provider Demographics
NPI:1306166699
Name:PEROCHO, MERIGEN PALMES (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:MERIGEN
Middle Name:PALMES
Last Name:PEROCHO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 CORPORATE BLVD. (JACKSON THERAPY PARTNERS)
Mailing Address - Street 2:STE 101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817
Mailing Address - Country:US
Mailing Address - Phone:877-896-3660
Mailing Address - Fax:
Practice Address - Street 1:11301 CORPORATE BLVD
Practice Address - Street 2:STE 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-8354
Practice Address - Country:US
Practice Address - Phone:877-896-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113342225X00000X
FL13903225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist