Provider Demographics
NPI:1609067412
Name:PEGLEY, DESMOND JOESPH (OTR/L)
Entity Type:Individual
Prefix:
First Name:DESMOND
Middle Name:JOESPH
Last Name:PEGLEY
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1866
Mailing Address - Country:US
Mailing Address - Phone:914-584-1011
Mailing Address - Fax:
Practice Address - Street 1:174 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-1866
Practice Address - Country:US
Practice Address - Phone:914-584-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013134-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist