Kiley Petencin

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT-1736 Issued in ID

Practice address

1460 Elk Creek Dr
Idaho Falls, ID 83404-8237

Phone

(208) 535-1286

NPI assigned

Apr 5, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR, ID2 enrollments

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Holistic Community Therapy LLC

  • Mental Health Occupational Therapist
  • Portland, OR
  • NPI 1073179776

  ID

  Medicare reassignment NPD
• Mountain View Hospital LLC

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1669462362
  NPD (past)
• Speech and Language Clinic, Inc

  • Speech-Language Pathologist
  • Ammon, ID
  • NPI 1891953519
  NPD (past)

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785110400000",
    "number": "1639810823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "197 E 19TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046020",
            "telephone_number": "434-825-4316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 ELK CREEK DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048237",
            "telephone_number": "208-535-1286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETENCIN",
        "first_name": "KILEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-05",
        "last_updated": "2026-07-27",
        "certification_date": "2026-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "ID",
            "license": "OT-1736",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "OR",
            "license": "379227",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Connectionstherapies.com",
            "affiliation": "N",
            "endpointDescription": "web-site",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1460 Elk Creek Dr",
            "city": "Idaho Falls",
            "state": "ID",
            "country_code": "US",
            "postal_code": "834048237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Personal Advantage Counseling
• Personal Care Services LLC
• Personal Growth Corporation
• Eric W. Perttula, M.D.
• Lisa Anne Perucca, LMSW
• Iris Peter, PA-C
• Ryne Shawn Peters, DO
• Betsy Pack Petersen, LMSW
• Emily Petersen
• Peterson Speech Therapy

• Occupational Therapist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Occupational Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.