Provider Demographics
NPI:1205012077
Name:FILOCK, PEGGY A (LCAT, CIMI)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:A
Last Name:FILOCK
Suffix:
Gender:F
Credentials:LCAT, CIMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8378 DEWEY RD
Mailing Address - Street 2:
Mailing Address - City:CATTARAUGUS
Mailing Address - State:NY
Mailing Address - Zip Code:14719-9685
Mailing Address - Country:US
Mailing Address - Phone:716-307-0929
Mailing Address - Fax:716-257-9490
Practice Address - Street 1:8378 DEWEY RD
Practice Address - Street 2:
Practice Address - City:CATTARAUGUS
Practice Address - State:NY
Practice Address - Zip Code:14719-9685
Practice Address - Country:US
Practice Address - Phone:716-307-0929
Practice Address - Fax:716-257-9490
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12052225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist