Provider Demographics
NPI:1154836336
Name:PECK, SARAH R (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:R
Last Name:PECK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:GRAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1530 DA NANG DR APT C
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3174
Mailing Address - Country:US
Mailing Address - Phone:484-426-8230
Mailing Address - Fax:
Practice Address - Street 1:1530 DA NANG DR APT C
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118
Practice Address - Country:US
Practice Address - Phone:484-426-8230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-09
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
385369224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant