Active NPI
Joanna Brooke Petersen, OTR/L
- Occupational Therapist
- Bossier City, LA
National Provider Identifier
1891390399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 324602
- Practice address
- 4680 Old Brownlee Rd
Bossier City, LA 71111 - Phone
- (318) 326-4259
- NPI assigned
- Dec 2, 2020
- 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 | 324602 | LA | Primary |
Addresses
Primary practice location
4680 Old Brownlee Rd
Bossier City, LA 71111
Mailing address
PO Box 342
Quitman, LA 71268-0342
Phone (318) 254-3052
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 |
|---|---|---|---|
| 324602 | LA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606867200000",
"number": "1891390399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 342",
"city": "QUITMAN",
"state": "LA",
"postal_code": "712680342",
"telephone_number": "318-254-3052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4680 OLD BROWNLEE RD",
"city": "BOSSIER CITY",
"state": "LA",
"postal_code": "71111",
"telephone_number": "318-326-4259"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "JOANNA",
"middle_name": "BROOKE",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-02",
"last_updated": "2020-12-02",
"certification_date": "2020-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "LA",
"license": "324602",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bossier City, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.