Active NPI
Alison Marie Penegor, OTR/L
- Occupational Therapist
- Stillwater, MN
National Provider Identifier
1245473065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 103712
- Practice address
- 1119 Owens St. N.
Stillwater, MN 55082 - Phone
- (651) 439-7180
- NPI assigned
- Apr 9, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 103712 | MN | Primary |
Addresses
Primary practice location
1119 Owens St. N.
Stillwater, MN 55082
Mailing address
4780 Centerville Rd.
Apt 315
White Bear Lake, MN 55127
Phone (906) 370-8188
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
| License | State | Type | Specialty |
|---|---|---|---|
| 103712 | MN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239235200000",
"number": "1245473065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4780 CENTERVILLE RD.",
"address_2": "APT 315",
"city": "WHITE BEAR LAKE",
"state": "MN",
"postal_code": "55127",
"telephone_number": "906-370-8188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1119 OWENS ST. N.",
"city": "STILLWATER",
"state": "MN",
"postal_code": "55082",
"telephone_number": "651-439-7180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENEGOR",
"first_name": "ALISON",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-04-09",
"last_updated": "2009-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MN",
"license": "103712",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stillwater, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.