Provider Demographics
NPI:1528395878
Name:POST, PEGGY JEAN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:JEAN
Last Name:POST
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:JEAN
Other - Last Name:BOOMSMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1130 N. MARGARET ST.
Mailing Address - Street 2:
Mailing Address - City:MARKESAN
Mailing Address - State:WI
Mailing Address - Zip Code:53946
Mailing Address - Country:US
Mailing Address - Phone:920-398-2751
Mailing Address - Fax:920-398-3937
Practice Address - Street 1:1130 N. MARGARET ST.
Practice Address - Street 2:
Practice Address - City:MARKESAN
Practice Address - State:WI
Practice Address - Zip Code:53946
Practice Address - Country:US
Practice Address - Phone:920-398-2751
Practice Address - Fax:920-398-3937
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI916-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant