Active NPI
Dan James Peterson, OTR
- Occupational Therapist
- Machesney Park, IL
National Provider Identifier
1346480944
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 056.005652
- Practice address
- 3032 Hamlin Dr
Machesney Park, IL 61115-7637 - Phone
- (815) 319-3333
- NPI assigned
- Feb 23, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 | 056.005652 | IL | Primary |
Addresses
Primary practice location
3032 Hamlin Dr
Machesney Park, IL 61115-7637
Mailing address
3032 Hamlin Dr
Machesney Park, IL 61115-7637
Phone (815) 319-3333
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056.005652 | IL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235347200000",
"number": "1346480944",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3032 HAMLIN DR",
"city": "MACHESNEY PARK",
"state": "IL",
"postal_code": "611157637",
"telephone_number": "815-319-3333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3032 HAMLIN DR",
"city": "MACHESNEY PARK",
"state": "IL",
"postal_code": "611157637",
"telephone_number": "815-319-3333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "DAN",
"middle_name": "JAMES",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-02-23",
"last_updated": "2009-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056.005652",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Machesney Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 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.