Provider Demographics
NPI:1437687811
Name:PETIT, AUDREY (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:PETIT
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3343 TIMBER RUN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-4119
Mailing Address - Country:US
Mailing Address - Phone:614-260-4105
Mailing Address - Fax:
Practice Address - Street 1:1650 RIDGEVIEW RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2962
Practice Address - Country:US
Practice Address - Phone:614-487-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT008231225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist