Healthcare Provider Details

I. General information

NPI: 1801860721
Provider Name (Legal Business Name): KAREN YVONNE PECK ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 BREWERTON RD DEPARTMENT OF PHYSICAL EDUCATION
WEST POINT NY
10996-1602
US

IV. Provider business mailing address

40 WILSON RD APT. I
WEST POINT NY
10996-1919
US

V. Phone/Fax

Practice location:
  • Phone: 845-938-2352
  • Fax:
Mailing address:
  • Phone: 845-527-6463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: