Provider Demographics
NPI:1992755474
Name:PEGG, KRISTY (OT, CHT)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:
Last Name:PEGG
Suffix:
Gender:F
Credentials:OT, CHT
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:KREIDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:360 SAN MIGUEL DR
Mailing Address - Street 2:STE 302
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7853
Mailing Address - Country:US
Mailing Address - Phone:949-644-6050
Mailing Address - Fax:949-644-4427
Practice Address - Street 1:360 SAN MIGUEL DR
Practice Address - Street 2:STE 302
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7853
Practice Address - Country:US
Practice Address - Phone:949-644-6050
Practice Address - Fax:949-644-4427
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9132225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOT9132AMedicare PIN