Provider Demographics
NPI:1811392699
Name:PETERSEN, NATALIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 S STATE ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1963
Mailing Address - Country:US
Mailing Address - Phone:215-550-6109
Mailing Address - Fax:
Practice Address - Street 1:16 S STATE ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1963
Practice Address - Country:US
Practice Address - Phone:215-550-6109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC013579225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist