Individual
KYMN M PEACOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13390 PENNOCK AVE, APPLE VALLEY, MN 55124-7359
(952) 236-0439
Mailing address
13390 PENNOCK AVE, APPLE VALLEY, MN 55124-7359
(952) 236-0439
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
100731
MN
Other
Enumeration date
02/16/2009
Last updated
02/16/2009
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