Healthcare Provider Details

I. General information

NPI: 1700702305
Provider Name (Legal Business Name): EMILY HOLDER PEACOCK OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 BRIGHTON TRL
FLORENCE MS
39073-6036
US

IV. Provider business mailing address

538 BRIGHTON TRL
FLORENCE MS
39073-6036
US

V. Phone/Fax

Practice location:
  • Phone: 601-974-0633
  • Fax:
Mailing address:
  • Phone: 601-974-0633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT-4156
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: