Provider Demographics
NPI:1811237621
Name:PEACOCK, ALLIE GREEN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ALLIE
Middle Name:GREEN
Last Name:PEACOCK
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 1:1000 1ST ST E
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4924
Mailing Address - Country:US
Mailing Address - Phone:281-540-2001
Mailing Address - Fax:281-540-2789
Practice Address - Street 1:1000 1ST ST E
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4924
Practice Address - Country:US
Practice Address - Phone:281-540-2001
Practice Address - Fax:281-540-2789
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115243225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist