Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 114614 | TX |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 114614 | TX |
NPI | 1063886299 |
---|---|
Provider Name | Katie Peacock |
First Address | Allen, TX 75013-5395 |
Second Address | Allen, TX 75013-5395 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2015 |
Last Update Date | 27/11/2015 |