Audrey Susan Petzold, OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

1181 Issued in NM

Practice address

32 Cuchilla de Lupe Rd
Placitas, NM 87043-8716

Phone

(505) 867-5203

NPI assigned

Aug 2, 2013

Last updated

Aug 2, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1375401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375401600000",
    "number": "1700218526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 CUCHILLA DE LUPE RD",
            "city": "PLACITAS",
            "state": "NM",
            "postal_code": "870438716",
            "telephone_number": "505-867-5203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 CUCHILLA DE LUPE RD",
            "city": "PLACITAS",
            "state": "NM",
            "postal_code": "870438716",
            "telephone_number": "505-867-5203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETZOLD",
        "first_name": "AUDREY",
        "middle_name": "SUSAN",
        "name_prefix": "Ms.",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-08-02",
        "last_updated": "2013-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NM",
            "license": "1181",
            "primary": false
        },
        {
            "code": "225XM0800X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Mental Health",
            "state": "NM",
            "license": "1181",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NM",
            "license": "1181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jonathan Reade, MSW
• Red Lotus Counseling Inc
• Sandia Vista Therapy LLC

• Pediatric Occupational Therapist in Placitas, NM
• Providers in Placitas, NM by specialty
• Pediatric Occupational Therapist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2013; 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.