Provider Demographics
NPI:1083947402
Name:PECK, MILOE ELISABETH (OTA)
Entity Type:Individual
Prefix:MRS
First Name:MILOE
Middle Name:ELISABETH
Last Name:PECK
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 LILAC TER
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-1829
Mailing Address - Country:US
Mailing Address - Phone:501-813-7919
Mailing Address - Fax:
Practice Address - Street 1:407 CARSON ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6852
Practice Address - Country:US
Practice Address - Phone:501-624-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARO-T0965225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics