Provider Demographics
NPI:1922398684
Name:PERREAULT, BARBARA LOUANNE (OTA)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:LOUANNE
Last Name:PERREAULT
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-9277
Mailing Address - Country:US
Mailing Address - Phone:978-771-9458
Mailing Address - Fax:
Practice Address - Street 1:4044 W LAKE MARY BLVD
Practice Address - Street 2:104-245
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2012
Practice Address - Country:US
Practice Address - Phone:800-226-9917
Practice Address - Fax:800-224-6215
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 11667224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant