Provider Demographics
NPI:1366907867
Name:PELOT, TERRY (OTR)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:PELOT
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6414 E LIMITS RD
Mailing Address - Street 2:
Mailing Address - City:VESPER
Mailing Address - State:WI
Mailing Address - Zip Code:54489-9437
Mailing Address - Country:US
Mailing Address - Phone:715-540-0014
Mailing Address - Fax:
Practice Address - Street 1:6414 E LIMITS RD
Practice Address - Street 2:
Practice Address - City:VESPER
Practice Address - State:WI
Practice Address - Zip Code:54489-9437
Practice Address - Country:US
Practice Address - Phone:715-540-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT19167225X00000X
HIOT1757225X00000X
WI6291225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist