Bennet Petersen, MS, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

6674-26 Issued in WI

Practice address

10222 74TH St Ste 211
Kenosha, WI 53142-6810

Phone

(262) 925-5020

Fax

(262) 925-5021

NPI assigned

Aug 28, 2011

Sex

Male

Sole proprietor

No

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)

Enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1314489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591315200000",
    "number": "1700166295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3921 30TH AVE STE C",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441957",
            "telephone_number": "262-925-5004",
            "fax_number": "262-925-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10222 74TH ST STE 211",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531426810",
            "telephone_number": "262-925-5020",
            "fax_number": "262-925-5021"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3506 Jordan Ln",
            "address_purpose": "LOCATION",
            "city": "North Las Vegas",
            "state": "NV",
            "postal_code": "890320516",
            "country_code": "US",
            "telephone_number": "847-380-0896",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "BENNET",
        "credential": "MS, OTR/L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-28",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "6674-26",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Pestka
• Peter L. Emer, O.D.
• Brandi Peters, LAT
• Jennie L Peters, PMHNP-BC, FNP
• Lori Peters, RN
• Dawn Petersen, CSAC
• Jenny Petersen
• Kristen K Petersen, SLP
• Chelsey Ruth Peterson
• Craig A. Peterson, D.M.D

• Occupational Therapist in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Occupational Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2020; 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.