Active NPI
Chalise Petersen
- Recreation Therapist
- Hurricane, UT
National Provider Identifier
1659172096
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 14208038-4003
- Practice address
- 65 N 1150 W
Hurricane, UT 84737-2062 - Phone
- (435) 879-7677
- NPI assigned
- Mar 21, 2025
- Last updated
- Mar 21, 2025
- 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 |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 14208038-4003 | UT | Primary |
Addresses
Primary practice location
65 N 1150 W
Hurricane, UT 84737-2062
Mailing address
5500 Ming Ave Ste 410
Bakersfield, CA 93309-4631
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14208038-4003 | Other | UT | LICENSE |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14208038-4003 | UT | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1742515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742515200000",
"number": "1659172096",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5500 MING AVE STE 410",
"city": "BAKERSFIELD",
"state": "CA",
"postal_code": "933094631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "65 N 1150 W",
"city": "HURRICANE",
"state": "UT",
"postal_code": "847372062",
"telephone_number": "435-879-7677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "CHALISE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-03-21",
"last_updated": "2025-03-21",
"certification_date": "2025-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "UT",
"license": "14208038-4003",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "14208038-4003",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hurricane, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.