Active NPI
Cathy Ann Peck, COTA
- Occupational Therapy Assistant
- Jonesboro, AR
National Provider Identifier
1255650628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OT-A603
- Practice address
- 810 Joe Brooks Dr
Jonesboro, AR 72401-4133 - Phone
- (870) 931-6789
- Fax
- (870) 931-4363
- NPI assigned
- May 25, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | OT-A603 | AR | Primary |
Addresses
Primary practice location
810 Joe Brooks Dr
Jonesboro, AR 72401-4133
Mailing address
PO Box 1994
Rolla, MO 65402-1994
Phone (573) 308-6248
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659437945 | Medicaid | AR |
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 |
|---|---|---|---|
| OT-A603 | AR | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274745600000",
"number": "1255650628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1994",
"city": "ROLLA",
"state": "MO",
"postal_code": "654021994",
"telephone_number": "573-308-6248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "810 JOE BROOKS DR",
"city": "JONESBORO",
"state": "AR",
"postal_code": "724014133",
"telephone_number": "870-931-6789",
"fax_number": "870-931-4363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PECK",
"first_name": "CATHY",
"middle_name": "ANN",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-05-25",
"last_updated": "2010-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "AR",
"license": "OT-A603",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1659437945",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jonesboro, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.