Individual
KINGSLEY PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
882 OAKMAN BLVD, DETROIT, MI 48238-3710
(313) 961-7990
Mailing address
1313 YORKTOWN ST, GROSSE POINTE WOODS, MI 48236-1033
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201007865
MI
Other
Enumeration date
12/13/2013
Last updated
12/13/2013
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