Active NPI
Angelina C Pecak, OTR
- Occupational Therapist
- Glendale, AZ
National Provider Identifier
1659696474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 4505
- Practice address
- 18555 N 79TH Ave
Ste B101
Glendale, AZ 85308-8370 - Phone
- (623) 487-7080
- Fax
- (623) 487-4897
- NPI assigned
- Apr 5, 2010
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 4505 | AZ | Primary |
Addresses
Primary practice location
18555 N 79TH Ave
Ste B101
Glendale, AZ 85308-8370
Mailing address
18555 N 79TH Ave
B101
Glendale, AZ 85308-8370
Phone (623) 487-7080
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 |
|---|---|---|---|
| 4505 | AZ | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270425600000",
"number": "1659696474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18555 N 79TH AVE",
"address_2": "B101",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853088370",
"telephone_number": "623-487-7080",
"fax_number": "623-487-4897"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18555 N 79TH AVE",
"address_2": "STE B101",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853088370",
"telephone_number": "623-487-7080",
"fax_number": "623-487-4897"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PECAK",
"first_name": "ANGELINA",
"middle_name": "C",
"name_prefix": "Miss",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-04-05",
"last_updated": "2010-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AZ",
"license": "4505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 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.