Provider Demographics
NPI:1831347079
Name:PERRY, MICHELE L (BCABA)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:PERRY
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100339
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33910-0339
Mailing Address - Country:US
Mailing Address - Phone:239-565-6848
Mailing Address - Fax:
Practice Address - Street 1:5337 BAYSHORE AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-5805
Practice Address - Country:US
Practice Address - Phone:239-565-6848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist