Shawna VI Petersilie, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

18-00496 Issued in KS

Practice address

2700 Canal Blvd
Hays, KS 67601-1702

Phone

(785) 625-7331

NPI assigned

Feb 22, 2019

Sex

Female

Sole proprietor

Yes

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

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": "1550793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550793600000",
    "number": "1194282509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "566 W 6TH ST",
            "city": "HOISINGTON",
            "state": "KS",
            "postal_code": "675442021",
            "telephone_number": "620-786-1979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 CANAL BLVD",
            "city": "HAYS",
            "state": "KS",
            "postal_code": "676011702",
            "telephone_number": "785-625-7331"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1401 Cherry Ln",
            "address_purpose": "LOCATION",
            "city": "Great Bend",
            "state": "KS",
            "postal_code": "675303152",
            "country_code": "US",
            "telephone_number": "620-792-2165",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "566 W 6th St",
            "address_purpose": "LOCATION",
            "city": "Hoisington",
            "state": "KS",
            "postal_code": "675442021",
            "country_code": "US",
            "telephone_number": "620-786-1979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSILIE",
        "first_name": "SHAWNA",
        "middle_name": "VI",
        "name_prefix": "Mrs.",
        "credential": "COTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-22",
        "last_updated": "2019-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "KS",
            "license": "18-00496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapy Assistant in Hays, KS
• Providers in Hays, KS by specialty
• Occupational Therapy Assistant in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 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.