NPI 1316528797

Nicholas Tyler Peacock, LCOTA

Practitioner Occupational Therapy Assistant Champaign, IL

Practice location

Address: 3001 Cherry Hills Dr, Champaign, IL 61822-7586
Phone: (217) 721-7799

Registered specialties

Occupational Therapy Assistant Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 224Z00000X Licence 057.005500 (IL)

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Registry record

NPI: 1316528797
Entity type: Individual
Sex (as registered): Male
NPI issued: 18 Apr 2021
Record last updated: 18 Apr 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.