Provider Demographics
NPI:1679153464
Name:PEDEN, STEVEN LEE (OTR/L)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:LEE
Last Name:PEDEN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ECRU
Mailing Address - State:MS
Mailing Address - Zip Code:38841-9785
Mailing Address - Country:US
Mailing Address - Phone:662-790-3559
Mailing Address - Fax:
Practice Address - Street 1:202 MARTINDALE LN
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-1355
Practice Address - Country:US
Practice Address - Phone:662-993-9105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3795225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist