Robert Petersen

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

Practice address

7105 W. 138TH Ave.
Cedar Lake, IN 46303

Phone

(219) 916-3668

NPI assigned

Oct 20, 2014

Sex

Male

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jacobs Ladder

  • Early Intervention Provider Agency
  • Valparaiso, IN
  • NPI 1255734042
  NPD (past)

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

{
    "created_epoch": "1413763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413763200000",
    "number": "1356745327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7105 W 138TH AVE",
            "city": "CEDAR LAKE",
            "state": "IN",
            "postal_code": "463039644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7105 W. 138TH AVE.",
            "city": "CEDAR LAKE",
            "state": "IN",
            "postal_code": "46303",
            "telephone_number": "219-916-3668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "ROBERT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-10-20",
        "last_updated": "2014-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Traci L Noble, MSW, LCSW
• Kathryn Oetting
• Daniel Osei-Bonsu, PHARMD MS RPH
• Margaret Parker, LCSW
• Brianna Rae Peternell
• Rehab Therapeutics, Inc
• Susan Russel
• Zubeyde Seda Sahin, PH.D.
• Theresa Lynn Sawaska, SLP-CCC
• Meredith Schuldes, COTA/L

• Occupational Therapy Assistant in Cedar Lake, IN
• Providers in Cedar Lake, IN by specialty
• Occupational Therapy Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2014; 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.