Provider Demographics
NPI:1588958276
Name:PEASLEY, TONIE LYN (OTR/L)
Entity type:Individual
Prefix:
First Name:TONIE
Middle Name:LYN
Last Name:PEASLEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 N FERDON BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-1706
Mailing Address - Country:US
Mailing Address - Phone:850-331-2987
Mailing Address - Fax:
Practice Address - Street 1:930 N FERDON BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-1706
Practice Address - Country:US
Practice Address - Phone:850-331-2987
Practice Address - Fax:850-398-5008
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT3119225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003712300Medicaid