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General NPI Number Information
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NPI Number | 1417558800
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Entity Type | Individual
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Provider Name | PEGGY S PETERS
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Gender | Female
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 323 SOUTH MAIN STREET
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City | TALLMADGE
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State | OH
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Zip | 44278-4427
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Country | US
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Telephone | 234-571-5876
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Fax |
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Provider Business Mailing Address
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Address Line | 190 FOX RIDGE WAY
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City | TALLMADGE
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State | OH
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Zip | 44278-3918
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Country | US
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Telephone | 234-571-5876
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number | 7718827
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License Number State | OH
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