Individual provider Active NPI

Alison Renee Petric, COTA/L

  • Occupational Therapy Assistant
  • Euclid, OH
National Provider Identifier
1104383967
Registry record updated Feb 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
OTA.007255 Issued in OH
Practice address
28230 Gilchrist Dr
Euclid, OH 44132-1324
Phone
(216) 392-8337
NPI assigned
Feb 27, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X OTA.007255 OH Primary

Addresses

Primary practice location

28230 Gilchrist Dr
Euclid, OH 44132-1324

Mailing address

339 E Maple St
North Canton, OH 44720-2593
Phone (330) 498-8200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
OTA.007255OHMDOccupational Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1551225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551225600000",
    "number": "1104383967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 E MAPLE ST",
            "city": "NORTH CANTON",
            "state": "OH",
            "postal_code": "447202593",
            "telephone_number": "330-498-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28230 GILCHRIST DR",
            "city": "EUCLID",
            "state": "OH",
            "postal_code": "441321324",
            "telephone_number": "216-392-8337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRIC",
        "first_name": "ALISON",
        "middle_name": "RENEE",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-27",
        "last_updated": "2019-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "OH",
            "license": "OTA.007255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Euclid, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.