Provider Demographics
NPI:1053698316
Name:PEISKEE, TERRI LYNN (MOT OTR)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:PEISKEE
Suffix:
Gender:F
Credentials:MOT OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15705 DEBBA DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-3564
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8868 RESEARCH BLVD
Practice Address - Street 2:SUITE 601
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-6497
Practice Address - Country:US
Practice Address - Phone:512-467-7232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102811225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics