Elise Rose Lichtenberg Peterson, MSOTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

10143483-4201 Issued in UT

Practice address

100 N Mario Capecchi Dr
Salt Lake City, UT 84113-1103

Phone

(801) 662-1000

NPI assigned

Oct 31, 2016

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

Other identifiers 1

Other names 1

• Elise Rose Lichtenberg Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1477872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585008000000",
    "number": "1194277749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N MARIO CAPECCHI DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841131103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N MARIO CAPECCHI DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841131103",
            "telephone_number": "801-662-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ELISE",
        "middle_name": "ROSE LICHTENBERG",
        "credential": "MSOTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-31",
        "last_updated": "2020-03-24",
        "certification_date": "2020-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "UT",
            "license": "10143483-4201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "942854057",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "NA",
            "affiliation": "N",
            "address_1": "100 N Mario Capecchi Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841131103",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ELISE",
            "last_name": "LICHTENBERG",
            "middle_name": "ROSE",
            "credential": "MSOTR/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David O. Peterson, M.D.
• David Scott Peterson, M.D.
• Dax W Peterson, LCSW
• Diana L Peterson, CNM
• Dillon Peterson
• Emily May Peterson
• Erik Shawn Peterson
• Gary L Peterson, DVM
• James T. Peterson, MD
• Jane Peterson, L.C.S.W.

• Occupational Therapist in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Occupational Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2020; 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.