Basic Information
| Provider Information | |||||||||
| NPI: | 1699054031 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PECKMAN | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MS, EIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2625 ANITA DR | ||||||||
| Address2: | |||||||||
| City: | GARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750412703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724909055 | ||||||||
| FaxNumber: | 9722650392 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 CUSTER RD | ||||||||
| Address2: | |||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750805623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724909055 | ||||||||
| FaxNumber: | 9722650392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2011 | ||||||||
| LastUpdateDate: | 08/16/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | TX | N | Other Service Providers | Case Manager/Care Coordinator | 222Q00000X | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist |
No ID Information.