Peden Pediatric Therapy, LLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

PEDEN PEDIATRIC THERAPY, LLC

Practice address

2363 Tutor Rd
Ecru, MS 38841-9106

Phone

(601) 480-8741

NPI assigned

Sep 6, 2023

Last updated

Sep 6, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Mallory Vance Peden, OTR/LNPI 1003424748

Title

Owner

Phone

(601) 480-8741

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mallory V Peden, MOT

  • Occupational Therapist
  • Tupelo, MS
  • NPI 1003424748
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1693958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1407632474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 236",
            "city": "ECRU",
            "state": "MS",
            "postal_code": "388410236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2363 TUTOR RD",
            "city": "ECRU",
            "state": "MS",
            "postal_code": "388419106",
            "telephone_number": "601-480-8741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDEN PEDIATRIC THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-06",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "PEDEN",
        "authorized_official_first_name": "MALLORY",
        "authorized_official_middle_name": "VANCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-480-8741",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael L Atkeison (Ecru Discount Pharmacy)
• Morrison Family Services, LLC
• Morrison's Family Services
• North Mississippi Medical Clinics Inc (Ecru Medical Clinic)
• Elizabeth Norton
• Pontotoc Health Services, Inc. (Children's Clinic-Ecru)
• Premise Health of Mississippi Medical PC (Ashley Wellness Center)
• Proactive MD Ms LLC (Ashley Wellness Center)
• Paige Sparks
• Terry Wade Stubblefield, R.PH.

• Occupational Therapist in Ecru, MS
• Providers in Ecru, MS by specialty
• Occupational Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.