Kimberly A Peterson, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT17912 Issued in CA

Practice address

1340 Lake Blvd
Davis, CA 95616-5673

Phone

(530) 753-5338

Fax

(530) 753-4609

NPI assigned

Oct 10, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sutter Valley Medical Foundation

  • Multi-Specialty Clinic/Center
  • Modesto, CA
  • NPI 1669846986
  Medicare reassignment Care Compare group NPD
• Sutter Valley Medical Foundation

  • Multi-Specialty Clinic/Center
  • Fairfield, CA
  • NPI 1184859894
  NPD
• Sutter Valley Medical Foundation

  • Durable Medical Equipment & Medical Supplies
  • Tracy, CA
  • NPI 1720930712
  NPD
• Sutter North Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Yuba City, CA
  • NPI 1144251521
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693353600000",
    "number": "1104336668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 255228",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958655228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 LAKE BLVD",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956165673",
            "telephone_number": "530-753-5338",
            "fax_number": "530-753-4609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-10",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "OT17912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Permanente Medical Group
• Alicia M Perry, LPC, LPCC
• Nick Robert Perry
• Michael S Petersen, M.D.
• Pamela O Petersen, M.D.
• Elizabeth Petteys
• Ellen J. Pettit, PH.D
• Brandy Pham, RPH
• Elizabeth W Pham, MD
• Khanhtram T Pham, PHARM.D

• Occupational Therapist in Davis, CA
• Providers in Davis, CA by specialty
• Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.