Active NPI
Andrea E Penacho, OTRL
- Occupational Therapist
- Cranston, RI
National Provider Identifier
1750331682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT00513
- Practice address
- 721 Reservoir Ave
Cranston, RI 02910-4430 - Phone
- (401) 946-4250
- Fax
- (401) 275-5645
- NPI assigned
- May 11, 2006
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT00513 | RI | Primary |
Addresses
Primary practice location
721 Reservoir Ave
Cranston, RI 02910-4430
Mailing address
227 Greenbrier Dr
Seekonk, MA 02771-5647
Phone (401) 484-4989
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 408949 | Other | RI | BLUECHIP RI IND. ID# |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT00513 | RI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609718400000",
"number": "1750331682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "227 GREENBRIER DR",
"city": "SEEKONK",
"state": "MA",
"postal_code": "027715647",
"telephone_number": "401-484-4989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "721 RESERVOIR AVE",
"city": "CRANSTON",
"state": "RI",
"postal_code": "029104430",
"telephone_number": "401-946-4250",
"fax_number": "401-275-5645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENACHO",
"first_name": "ANDREA",
"middle_name": "E",
"credential": "OTRL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-11",
"last_updated": "2021-01-04",
"certification_date": "2021-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "RI",
"license": "OT00513",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECHIP RI IND. ID#",
"identifier": "408949",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cranston, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.