Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 102811 | TX |
N | 225XP0200X | Occupational Therapist - Pediatrics | 102811 | TX |
NPI | 1053698316 |
---|---|
Provider Name | Terri Lynn Peiskee |
First Address | Lakeway, TX 78734-3564 |
Second Address | Austin, TX 78758-6497 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2011 |
Last Update Date | 20/11/2012 |