Individual
PEGGY KAY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
2906 S 20TH ST, LOWER LEVEL, MILWAUKEE, WI 53215-3732
(414) 385-6265
(414) 383-5597
Mailing address
2906 S 20TH ST, LOWER LEVEL, MILWAUKEE, WI 53215-3732
(414) 385-6265
(414) 383-5597
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3492
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41042300
—
WI
Enumeration date
02/02/2007
Last updated
07/08/2007
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