Provider Demographics
NPI:1730137704
Name:PECK, SCOTT HARRIS (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:HARRIS
Last Name:PECK
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 NE MADISON RD
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7971
Mailing Address - Country:US
Mailing Address - Phone:360-613-0405
Mailing Address - Fax:
Practice Address - Street 1:7070 STAMPEDE BLVD NW
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-8927
Practice Address - Country:US
Practice Address - Phone:360-662-2819
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer