Active NPI
Kimberly D Peterson, B.S. OTR/L
- Pediatric Occupational Therapist
- Waxhaw, NC
National Provider Identifier
1710155239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 6775
- Practice address
- 3022 Chisholm CT
Waxhaw, NC 28173-7865 - Phone
- (704) 843-2020
- Fax
- (704) 843-8384
- NPI assigned
- Feb 19, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 6775 | NC | Primary |
Addresses
Primary practice location
3022 Chisholm CT
Waxhaw, NC 28173-7865
Mailing address
4100 Exbury Gardens Dr
Waxhaw, NC 28173-6961
Phone (704) 256-4270
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
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6775 | NC | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Occupational Therapy South | Pediatrics | Past | Accepting new patients |
| Occupational Therapy South | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Developmental Therapist
- Waxhaw, NC
- NPI 1083898399
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203379200000",
"number": "1710155239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4100 EXBURY GARDENS DR",
"city": "WAXHAW",
"state": "NC",
"postal_code": "281736961",
"telephone_number": "704-256-4270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3022 CHISHOLM CT",
"city": "WAXHAW",
"state": "NC",
"postal_code": "281737865",
"telephone_number": "704-843-2020",
"fax_number": "704-843-8384"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "KIMBERLY",
"middle_name": "D",
"credential": "B.S. OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-19",
"last_updated": "2008-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "NC",
"license": "6775",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waxhaw, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.