Individual
NICHOLAS TYLER PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L/COTA
Contact information
Practice address
3001 CHERRY HILLS DR, CHAMPAIGN, IL 61822-7586
(217) 721-7799
Mailing address
3001 CHERRY HILLS DR, CHAMPAIGN, IL 61822-7586
(217) 721-7799
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.005500
IL
Other
Enumeration date
04/18/2021
Last updated
04/18/2021
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