Provider Demographics
NPI:1578605671
Name:PEACHER, MARRENE WHITE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARRENE
Middle Name:WHITE
Last Name:PEACHER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:MARRENE
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:40205 W MARY LOU DR.
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85239
Mailing Address - Country:US
Mailing Address - Phone:480-239-0224
Mailing Address - Fax:
Practice Address - Street 1:1402 E SOUTH MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-7925
Practice Address - Country:US
Practice Address - Phone:480-239-0224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2751225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ686199Medicare ID - Type UnspecifiedACCS NUMBER