Individual provider Active NPI

Erica Petru

  • Occupational Therapist
  • Lakewood, WA
National Provider Identifier
1336773209
Registry record updated Feb 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT.OT.61033580 Issued in WA
Practice address
9307 Bridgeport Way SW
Lakewood, WA 98499-1570
Phone
(253) 201-1234
NPI assigned
Feb 28, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT.OT.61033580 WA Primary

Addresses

Primary practice location

9307 Bridgeport Way SW
Lakewood, WA 98499-1570

Mailing address

9307 Bridgeport Way SW
Lakewood, WA 98499-1570
Phone (253) 201-1234

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

LicenseStateTypeSpecialty
OT.OT.61033580WAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Cole Sky Therapy PLLC Occupational Therapist CurrentSince Aug 28, 2022 Accepting new patients
Sky Bridge Therapies LLC Occupational Therapist PastSince Mar 1, 2020 Accepting new patients

Locations

9307 Bridgeport Way SW
Tacoma, WA 98499
Phone (253) 201-1234

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1582848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582848000000",
    "number": "1336773209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9307 BRIDGEPORT WAY SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984991570",
            "telephone_number": "253-201-1234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9307 BRIDGEPORT WAY SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984991570",
            "telephone_number": "253-201-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRU",
        "first_name": "ERICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-28",
        "last_updated": "2020-02-28",
        "certification_date": "2020-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WA",
            "license": "OT.OT.61033580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 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.