Provider Demographics
NPI:1154064798
Name:PHILLIPS-DINANT, PEGGY RENEE (COTA/L, CLT)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:RENEE
Last Name:PHILLIPS-DINANT
Suffix:
Gender:F
Credentials:COTA/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 LINK RD
Mailing Address - Street 2:
Mailing Address - City:WEST DECATUR
Mailing Address - State:PA
Mailing Address - Zip Code:16878-8321
Mailing Address - Country:US
Mailing Address - Phone:814-762-5403
Mailing Address - Fax:
Practice Address - Street 1:170 RED FOX DR
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-8338
Practice Address - Country:US
Practice Address - Phone:814-695-8425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP002367L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant