Provider Demographics
NPI:1528587821
Name:PETERSON, BECKY ANN (OTR)
Entity Type:Individual
Prefix:MS
First Name:BECKY
Middle Name:ANN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 WHIPPLE ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1662
Mailing Address - Country:US
Mailing Address - Phone:928-777-9897
Mailing Address - Fax:928-717-0019
Practice Address - Street 1:1045 WHIPPLE ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1662
Practice Address - Country:US
Practice Address - Phone:928-777-9897
Practice Address - Fax:928-717-0019
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7168225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist