Active NPI
Jaclyn Petermann, OTR/L
- Occupational Therapist
- Anderson, SC
National Provider Identifier
1306312228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 4975
- Practice address
- 208 James St
Anderson, SC 29625-2942 - Phone
- (864) 226-3427
- NPI assigned
- Oct 18, 2018
- Last updated
- Oct 18, 2018
- 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 | 4975 | SC | Primary |
Addresses
Primary practice location
208 James St
Anderson, SC 29625-2942
Mailing address
111 Montclaire Cir
Liberty, SC 29657-5200
Phone (862) 812-3014
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
701 Simpson Rd
Anderson, SC 29621-3077
Phone (800) 444-6845
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4975 | SC | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aegis Group Practice LLC | Occupational Therapist | Current | Accepting new patients |
| Aegis Group Practice LLC | Occupational Therapist | Current | Accepting new patients |
| Aegis Group Practice LLC | Occupational Therapist | Current | Accepting new patients |
Locations
4933 Old Greenwood Rd
Fort Smith, AR 72903
701 Simpson Rd
Anderson, SC 29621
Phone (864) 226-5505
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapist
- Indian Harbour Beach, FL
- NPI 1932072030
Occupational Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539820800000",
"number": "1306312228",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 MONTCLAIRE CIR",
"city": "LIBERTY",
"state": "SC",
"postal_code": "296575200",
"telephone_number": "862-812-3014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 JAMES ST",
"city": "ANDERSON",
"state": "SC",
"postal_code": "296252942",
"telephone_number": "864-226-3427"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERMANN",
"first_name": "JACLYN",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-18",
"last_updated": "2018-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "SC",
"license": "4975",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anderson, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.