Provider Demographics
NPI:1376847228
Name:PETERSEN, ARIEL D (OTR/L)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:D
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ARIEL
Other - Middle Name:D
Other - Last Name:FABYANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:77 HOBART AVE
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4207
Mailing Address - Country:US
Mailing Address - Phone:201-988-3023
Mailing Address - Fax:
Practice Address - Street 1:962 MANOR RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7011
Practice Address - Country:US
Practice Address - Phone:718-982-5994
Practice Address - Fax:718-494-2724
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13950225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist