Provider Demographics
NPI:1447260526
Name:LEBENSFELD, PEGGY (OCC THERAPIST)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:LEBENSFELD
Suffix:
Gender:F
Credentials:OCC THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 SE MIZNER BLVD
Mailing Address - Street 2:APT. 110B
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432
Mailing Address - Country:US
Mailing Address - Phone:560-251-4622
Mailing Address - Fax:888-552-6176
Practice Address - Street 1:6169 S JOG RD
Practice Address - Street 2:STE A11
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-6579
Practice Address - Country:US
Practice Address - Phone:561-432-0111
Practice Address - Fax:561-432-1075
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3290225X00000X
FL11977225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ16451Medicare Oscar/Certification
NYQ16451Medicare PIN