Provider Demographics
NPI:1447718861
Name:PECK, BRANDI ANNE (COTA)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:ANNE
Last Name:PECK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:ANNE
Other - Last Name:PECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14083 E TEMPLE DR APT 1313
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14083 E TEMPLE DR APT 1313
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-5625
Practice Address - Country:US
Practice Address - Phone:952-200-2982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTA-1400224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant