Provider Demographics
NPI:1538463476
Name:PECK, KAREN A
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:A
Last Name:PECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17633 CAPISTRANO LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8209
Mailing Address - Country:US
Mailing Address - Phone:708-479-4186
Mailing Address - Fax:
Practice Address - Street 1:17633 CAPISTRANO LN
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8209
Practice Address - Country:US
Practice Address - Phone:708-479-4186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist