Provider Demographics
NPI:1750638607
Name:MCROBERTS, PEGGY (OTR)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:MCROBERTS
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 1:170 E IROQUOIS ST
Mailing Address - Street 2:
Mailing Address - City:SHELDON
Mailing Address - State:IL
Mailing Address - Zip Code:60966-8186
Mailing Address - Country:US
Mailing Address - Phone:815-644-0967
Mailing Address - Fax:815-269-2142
Practice Address - Street 1:170 E IROQUOIS ST
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IL
Practice Address - Zip Code:60966-8186
Practice Address - Country:US
Practice Address - Phone:815-644-0967
Practice Address - Fax:815-269-2142
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056002621225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation