Individual
KELLY DENICE PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
251 HIGHWAY 66, NEW HARMONY, IN 47631-9075
(812) 682-4104
Mailing address
41 S GARDENGATE DR, HENDERSON, KY 42420-5527
(270) 748-2049
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001225A
IN
Other
Enumeration date
02/08/2012
Last updated
02/08/2012
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