Provider Demographics
NPI:1861191140
Name:PEARSON, MARIAH
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:PEARSON
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 1:1013 VALENCIA VISTA WAY APT 301
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4761
Mailing Address - Country:US
Mailing Address - Phone:440-231-1494
Mailing Address - Fax:
Practice Address - Street 1:1451 LAKEMIST LN
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5378
Practice Address - Country:US
Practice Address - Phone:407-818-2406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency