National Provider Identifier
Mary Lou Peacock, COTA
Mary Lou Peacock, COTA is listed in the NPPES registry with a primary specialty of Occupational Therapy Assistant in Buffalo, NY and a listed phone number of (716) 898-3949.
Profile Overview
- NPI
- 1588795512
- Provider Type
- Individual
- Primary Specialty
- Occupational Therapy Assistant
- Enumeration Date
- March 09, 2007
- Last Updated
- July 08, 2007
Practice Location
- 462 Grider St
- Buffalo, NY 14215-3021
Phone: (716) 898-3949
Mailing Address
- 4510 Hedgewood Dr
- Williamsville, NY 14221-6121
Specialties
- Occupational Therapy Assistant (224Z00000X)
Full Record
- NPI
- 1588795512
- Entity Type
- Individual
- Last Name
- Peacock
- First Name
- Mary
- Middle Name
- Lou
- Name Prefix
- Mrs.
- Credential
- COTA
- Provider Other Last Name
- Perpetus
- Provider Other First Name
- Mary
- Provider Other Middle Name
- Lou
- Provider Other Name Prefix Text
- Mrs.
- Provider Other Credential Text
- COTA
- Provider Other Last Name Type Code
- 1
- Mailing Street Address
- 4510 Hedgewood Dr
- Mailing City
- Williamsville
- Mailing State
- NY
- Mailing ZIP Code
- 14221-6121
- Mailing Country
- US
- Mailing Phone
- (716) 634-6654
- Practice Street Address
- 462 Grider St
- Practice City
- Buffalo
- Practice State
- NY
- Practice ZIP Code
- 14215-3021
- Practice Country
- US
- Practice Phone
- (716) 898-3949
- Enumeration Date
- March 09, 2007
- Last Updated
- July 08, 2007
- Sex
- Female
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Occupational Therapy Assistant (224Z00000X)