Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT5300 | CA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT5300 | CA |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT5300 | CA |
NPI | 1588042808 |
---|---|
Provider Name | Sherry Peck |
First Address | Huntington Beach, CA 92647-5622 |
Second Address | Huntington Beach, CA 92647-5622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2015 |
Last Update Date | 07/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT5300 | LICENSE (01) | CA |