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General NPI Number Information
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NPI Number | 1497968051
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Entity Type | Individual
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Provider Name | JENNIFER KRISTIN PECK OTR
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Gender | Female
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15600 SAN PEDRO AVE STE 307
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City | SAN ANTONIO
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State | TX
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Zip | 78232-3739
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Country | US
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Telephone | 800-437-7560
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Fax |
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Provider Business Mailing Address
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Address Line | 546 LINDLY ST
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-3414
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Country | US
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Telephone | 972-266-2201
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 108791
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License Number State | TX
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