Provider Demographics
NPI:1346304409
Name:PECK, DOTTIE (REEGT, CNIM)
Entity Type:Individual
Prefix:
First Name:DOTTIE
Middle Name:
Last Name:PECK
Suffix:
Gender:F
Credentials:REEGT, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3211
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-3211
Mailing Address - Country:US
Mailing Address - Phone:208-528-7566
Mailing Address - Fax:208-523-9224
Practice Address - Street 1:1361 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4208
Practice Address - Country:US
Practice Address - Phone:208-528-7566
Practice Address - Fax:208-523-9224
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic