Provider Demographics
NPI:1710424395
Name:PECK, JEAN M (OTR/L)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:PECK
Suffix:
Gender:F
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 1:2412 CUMING ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-1600
Mailing Address - Country:US
Mailing Address - Phone:402-717-3751
Mailing Address - Fax:402-717-3795
Practice Address - Street 1:2412 CUMING ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-1600
Practice Address - Country:US
Practice Address - Phone:402-717-3751
Practice Address - Fax:402-717-3795
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA092529225X00000X
NE272225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist