Active NPI
Kathleen Nora Peters, COTA
- Occupational Therapy Assistant
- New London, WI
National Provider Identifier
1770822413
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 1154-27
- Practice address
- 107 E Beckert Rd
New London, WI 54961-2509 - Phone
- (920) 982-5354
- Fax
- (920) 982-9149
- NPI assigned
- Jan 31, 2013
- 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 Therapy Assistant | 224Z00000X | 1154-27 | WI | Primary |
Addresses
Primary practice location
107 E Beckert Rd
New London, WI 54961-2509
Mailing address
107 E Beckert Road
New London, WI 54940
Phone (920) 982-5354
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154-27 | Other | WI | STATE 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 |
|---|---|---|---|
| 1154-27 | WI | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1359590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359590400000",
"number": "1770822413",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 E BECKERT ROAD",
"city": "NEW LONDON",
"state": "WI",
"postal_code": "54940",
"telephone_number": "920-982-5354",
"fax_number": "920-982-9149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 E BECKERT RD",
"city": "NEW LONDON",
"state": "WI",
"postal_code": "549612509",
"telephone_number": "920-982-5354",
"fax_number": "920-982-9149"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERS",
"first_name": "KATHLEEN",
"middle_name": "NORA",
"name_prefix": "Mrs.",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-01-31",
"last_updated": "2013-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WI",
"license": "1154-27",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "1154-27",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in New London, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 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.