Provider Demographics
NPI:1558568790
Name:RYAN, PEGGY L (OTR)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:L
Last Name:RYAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6823 S 900 E
Mailing Address - Street 2:
Mailing Address - City:CANNELBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47519-5085
Mailing Address - Country:US
Mailing Address - Phone:812-644-7545
Mailing Address - Fax:
Practice Address - Street 1:801 S STATE ROAD 57
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-4373
Practice Address - Country:US
Practice Address - Phone:812-254-4616
Practice Address - Fax:812-254-4765
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003464A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist