Provider Demographics
NPI:1306266754
Name:PEREZ, MICHELE AGUSTINA
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:AGUSTINA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 NE 21ST PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-4608
Mailing Address - Country:US
Mailing Address - Phone:786-712-7081
Mailing Address - Fax:239-457-1008
Practice Address - Street 1:1801 NE 21ST PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-4608
Practice Address - Country:US
Practice Address - Phone:786-712-7081
Practice Address - Fax:239-457-1008
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-21-53727103K00000X, 103K00000X
FLOTA13380224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant