Basic Information
| Provider Information | |||||||||
| NPI: | 1548905920 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PECOY | ||||||||
| FirstName: | ALEISE | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3027 BUCKEYE POINTE DR | ||||||||
| Address2: | |||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338815915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076927811 | ||||||||
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| Practice Location | |||||||||
| Address1: | 606 S 9TH ST | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347486320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3528054404 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2022 | ||||||||
| LastUpdateDate: | 05/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 18910 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.