Provider Demographics
NPI:1922774207
Name:PERALTA, JAZMIN (OTR/L)
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:
Last Name:PERALTA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JAZMIN
Other - Middle Name:
Other - Last Name:HIDALGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 E MONUMENT AVE UNIT 410
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5774
Mailing Address - Country:US
Mailing Address - Phone:407-904-5285
Mailing Address - Fax:407-987-5236
Practice Address - Street 1:1172 W OSCEOLA PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7515
Practice Address - Country:US
Practice Address - Phone:689-204-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT21788225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist