Provider Demographics
NPI:1952462459
Name:PEAT, KATIE (OTR)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:PEAT
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 1:2521 E MARKET ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NAPPANEE
Mailing Address - State:IN
Mailing Address - Zip Code:46550-9396
Mailing Address - Country:US
Mailing Address - Phone:574-773-7733
Mailing Address - Fax:574-773-7133
Practice Address - Street 1:2521 E MARKET ST
Practice Address - Street 2:SUITE A
Practice Address - City:NAPPANEE
Practice Address - State:IN
Practice Address - Zip Code:46550-9396
Practice Address - Country:US
Practice Address - Phone:574-773-7733
Practice Address - Fax:574-773-7133
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001666A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200395180AMedicaid
IN200555OtherCSHS PROVIDER NUMBER