Healthcare Provider Details

I. General information

NPI: 1124266697
Provider Name (Legal Business Name): MISTI KAY PEPPLER M.S., OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14N970 SLEEPY HOLLOW RD
DUNDEE IL
60118-9111
US

IV. Provider business mailing address

14N970 SLEEPY HOLLOW RD
DUNDEE IL
60118-9111
US

V. Phone/Fax

Practice location:
  • Phone: 773-469-6390
  • Fax:
Mailing address:
  • Phone: 773-469-6390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056.006043
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056-00643
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: