Individual
TARA MCPEAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR
Contact information
Practice address
N5509 36TH DR, FREMONT, WI 54940-8625
(920) 538-2210
Mailing address
N5509 36TH DR, FREMONT, WI 54940-8625
(920) 538-2210
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1076273
NBCOT
WI
05
—
5709-26
—
WI
Enumeration date
05/24/2007
Last updated
05/09/2017
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