Provider Demographics
NPI:1174614788
Name:PEICK, DENISE RAE (OTR L)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:RAE
Last Name:PEICK
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:RAE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19870 ITERI PLACE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044
Mailing Address - Country:US
Mailing Address - Phone:952-985-8474
Mailing Address - Fax:
Practice Address - Street 1:THE THERAPY PLACE
Practice Address - Street 2:900 W 94TH ST
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420
Practice Address - Country:US
Practice Address - Phone:952-885-0418
Practice Address - Fax:952-885-0173
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100867225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics