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General NPI Number Information
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NPI Number | 1316350036
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Entity Type | Organization
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Legal Business Name | KASSIE PECK, PLLC
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Dates
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Enumeration Date | 06/10/2014
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 2033 W. HOUSTON STREET
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City | BROKEN ARROW
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State | OK
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Zip | 74012
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Country | US
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Telephone | 405-537-9101
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Fax | 918-512-4823
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Provider Business Mailing Address
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Address Line | 2033 W HOUSTON STREET
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City | BROKEN ARROW
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State | OK
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Zip | 74012
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Country | US
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Telephone | 405-537-9101
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Fax | 918-512-4823
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Authorized Official
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Title or Position | OWNER
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Name | KASSIE ANN ALLISON
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Credential | OTR/L
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Telephone | 918-404-1535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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