Provider Demographics
NPI:1124266697
Name:PEPPLER, MISTI KAY (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:MISTI
Middle Name:KAY
Last Name:PEPPLER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14N970 SLEEPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-9111
Mailing Address - Country:US
Mailing Address - Phone:773-469-6390
Mailing Address - Fax:
Practice Address - Street 1:14N970 SLEEPY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-9111
Practice Address - Country:US
Practice Address - Phone:773-469-6390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.006043225XP0200X
IL056-00643225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics