MEDICARE: SHERIDAN L PECK OT

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	282835-4201	UT

General Provider Information

NPI Number	:	1659427995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERIDAN L PECK OT

Provider Business Mailing Address
First Line	:	1068 S 470 E
Second Line	:
City	:	PROVIDENCE
State	:	UT
Zip	:	84332-9501
Country	:	US
Telephone Number	:	435-752-3920
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 S 200 W
Second Line	:
City	:	RICHMOND
State	:	UT
Zip	:	84333-1267
Country	:	US
Telephone Number	:	435-258-5601
Fax Number	:

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

Provider Enumeration Date	:	01/27/2007
Last Update Date	:	07/08/2007

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Directions to “ SHERIDAN L PECK OT” Practice Location

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