Provider Demographics
NPI:1588792717
Name:PERERA, MELESANDE MARIE (MS OTR)
Entity type:Individual
Prefix:MISS
First Name:MELESANDE
Middle Name:MARIE
Last Name:PERERA
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16356 N THOMPSON PEAK PKWY APT 1033N
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2130
Mailing Address - Country:US
Mailing Address - Phone:269-267-1210
Mailing Address - Fax:
Practice Address - Street 1:8190 W DEER VALLEY RD STE 104-200
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2126
Practice Address - Country:US
Practice Address - Phone:269-267-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3746225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics