Basic Information
| Provider Information | |||||||||
| NPI: | 1104802958 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3115 CUMBERLAND AVE | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767071220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547570640 | ||||||||
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| Practice Location | |||||||||
| Address1: | KLARAS CHILDREN'S CENTER ECI | ||||||||
| Address2: | 110 S. 12TH STREET | ||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767030890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547523451 | ||||||||
| FaxNumber: | 2542962932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 09/06/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | 106433 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.