Active NPI
Patricia Baxter Petralia, O.T.
- Occupational Therapist
- Broomall, PA
National Provider Identifier
1376853689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OC-00077-L
- Practice address
- 712 Winchester Rd
Broomall, PA 19008-3431 - Phone
- (610) 325-0262
- NPI assigned
- Oct 20, 2010
- 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 | OC-00077-L | PA | Primary |
Addresses
Primary practice location
712 Winchester Rd
Broomall, PA 19008-3431
Mailing address
712 Winchester Rd
Broomall, PA 19008-3431
Phone (610) 325-0262
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 |
|---|---|---|---|
| OC-00077-L | PA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312761600000",
"number": "1376853689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "712 WINCHESTER RD",
"city": "BROOMALL",
"state": "PA",
"postal_code": "190083431",
"telephone_number": "610-325-0262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "712 WINCHESTER RD",
"city": "BROOMALL",
"state": "PA",
"postal_code": "190083431",
"telephone_number": "610-325-0262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRALIA",
"first_name": "PATRICIA",
"middle_name": "BAXTER",
"credential": "O.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-10-20",
"last_updated": "2011-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "PA",
"license": "OC-00077-L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Broomall, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.