Active NPI
Karen Ann Peck, CTRS, CLC, CST, QST
- Recreation Therapist
- South Windsor, CT
National Provider Identifier
1073017372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 12771
- Practice address
- 469 Buckland Rd Ste 102
South Windsor, CT 06074-3737 - Phone
- (860) 432-9923
- NPI assigned
- Mar 21, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 12771 | CT | Primary |
Addresses
Primary practice location
469 Buckland Rd Ste 102
South Windsor, CT 06074-3737
Mailing address
469 Buckland Rd Ste 102
South Windsor, CT 06074-3737
Phone (860) 432-9923
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12771 | CT | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1521590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521590400000",
"number": "1073017372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "469 BUCKLAND RD STE 102",
"city": "SOUTH WINDSOR",
"state": "CT",
"postal_code": "060743737",
"telephone_number": "860-432-9923"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "469 BUCKLAND RD STE 102",
"city": "SOUTH WINDSOR",
"state": "CT",
"postal_code": "060743737",
"telephone_number": "860-432-9923"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PECK",
"first_name": "KAREN",
"middle_name": "ANN",
"credential": "CTRS, CLC, CST, QST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-21",
"last_updated": "2018-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "CT",
"license": "12771",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Windsor, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.