Peninsula Pediatric Therapy, Inc.

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

334 Issued in AK

Legal business name

PENINSULA PEDIATRIC THERAPY, INC.

Practice address

7335 Palmer Wasilla Hwy
Palmer, AK 99645-6007

Phone

(907) 250-1151

Fax

(907) 782-4202

NPI assigned

Oct 8, 2013

Organization subpart

No

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

Authorized official

Name

Ms. Shani Lazell Dean, MS, CCC-SLP

Title

President

Phone

(907) 250-1151

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1381190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431561600000",
    "number": "1194152058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9040 E GOLD PAN DR",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996459684",
            "telephone_number": "907-250-1151",
            "fax_number": "907-782-4202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7335 PALMER WASILLA HWY",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996456007",
            "telephone_number": "907-250-1151",
            "fax_number": "907-782-4202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA PEDIATRIC THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-08",
        "last_updated": "2015-05-14",
        "status": "A",
        "authorized_official_last_name": "DEAN",
        "authorized_official_first_name": "SHANI",
        "authorized_official_middle_name": "LAZELL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "907-250-1151",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS, CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "AK",
            "license": "334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1603051",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Paulick, PSYD
• Kathryn A Paulson, CCC-SLP
• Kaitlin Peace, MD
• Peaceful Center Occupational Therapy, LLC.
• Amber L Pell
• Jerod Perron
• Emmali Jean Peters
• Jennifer Hill Peters, OTR/L
• Camylle Peterson
• Kyrin Peterson

• Multi-Specialty Clinic/Center in Palmer, AK
• Providers in Palmer, AK by specialty
• Multi-Specialty Clinic/Center in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2015; 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.