Active NPI
Therese Pettersen
- Occupational Therapist
- Phoenix, AZ
National Provider Identifier
1396513347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 009304
- Practice address
- 775 E Willetta St
Phoenix, AZ 85006-2723 - Phone
- (480) 581-3900
- NPI assigned
- Dec 19, 2023
- 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 | 009304 | AZ | Primary |
Addresses
Primary practice location
775 E Willetta St
Phoenix, AZ 85006-2723
Mailing address
1550 E Campbell Ave Apt 4016
Phoenix, AZ 85014-4279
Phone (602) 989-8096
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 |
|---|---|---|---|
| 009304 | AZ | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1702944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704412800000",
"number": "1396513347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1550 E CAMPBELL AVE APT 4016",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850144279",
"telephone_number": "602-989-8096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "775 E WILLETTA ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850062723",
"telephone_number": "480-581-3900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTERSEN",
"first_name": "THERESE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-12-19",
"last_updated": "2024-01-05",
"certification_date": "2024-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AZ",
"license": "009304",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.