Provider Demographics
NPI:1841490216
Name:PEATS, JACKI LYNN (CMT)
Entity type:Individual
Prefix:
First Name:JACKI
Middle Name:LYNN
Last Name:PEATS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7785 MULE DEER PL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80125-8869
Mailing Address - Country:US
Mailing Address - Phone:303-807-1961
Mailing Address - Fax:303-796-0197
Practice Address - Street 1:7785 MULE DEER PL
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80125-8869
Practice Address - Country:US
Practice Address - Phone:303-807-1961
Practice Address - Fax:303-796-0197
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1028101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist