MEDICARE: PEGGY C FYE OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	004140	MO

General Provider Information

NPI Number	:	1598939415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGGY C FYE OTR/L

Provider Business Mailing Address
First Line	:	10016 NW AMBASSADOR DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64153-1362
Country	:	US
Telephone Number	:	816-891-7162
Fax Number	:	816-891-6704

Provider Business Practice Location Address
First Line	:	10016 NW AMBASSADOR DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64153-1362
Country	:	US
Telephone Number	:	816-891-7162
Fax Number	:	816-891-6704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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