Lisa Irene Petersen, OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

02203-1 Issued in NY

Practice address

125 Middletown Rd
Waterford, NY 12188-1516

Phone

(518) 237-0800

Fax

(518) 687-2643

NPI assigned

Nov 13, 2019

Sex

Female

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)

Not enrolled

State licenses

Practice roles

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.

• Waterford-Halfmoon Ufsd

  • Local Education Agency (LEA)
  • Waterford, NY
  • NPI 1720143506
  NPD (past)

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

{
    "created_epoch": "1573603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573603200000",
    "number": "1831734961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 MIDDLETOWN RD",
            "city": "WATERFORD",
            "state": "NY",
            "postal_code": "121881516",
            "telephone_number": "518-237-0800",
            "fax_number": "518-687-2643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 MIDDLETOWN RD",
            "city": "WATERFORD",
            "state": "NY",
            "postal_code": "121881516",
            "telephone_number": "518-237-0800",
            "fax_number": "518-687-2643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "LISA",
        "middle_name": "IRENE",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-13",
        "last_updated": "2019-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NY",
            "license": "02203-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zahid Nazir, M.D.
• Paul Anthony Noto, PT, DPT
• Jennifer Rose Oneill, LPN
• Cody Paquin, EMT
• Patregnani & Morra DDS PLLC
• Lois Jean Potrzuski, SLP
• Premise Health of New York Medical, P.C (Momentive Performance Materials)
• Elise C. Richtol, DPM
• Frank J Robinson, DC
• Tamika Rosario, REGISTERED NURSE

• Pediatric Occupational Therapist in Waterford, NY
• Providers in Waterford, NY by specialty
• Pediatric Occupational Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2019; 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.