Provider Demographics
NPI:1275070203
Name:PEAK, MELODY (COTA)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:PEAK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 COUNTY ROAD 125
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315-9517
Mailing Address - Country:US
Mailing Address - Phone:419-560-7839
Mailing Address - Fax:
Practice Address - Street 1:7326 STATE ROUTE 19
Practice Address - Street 2:UNIT 2614
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-9354
Practice Address - Country:US
Practice Address - Phone:419-348-8531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-29
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA005062224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant