Provider Demographics
NPI:1952444101
Name:PETERSON, AIMEE CATHERINE (OTRL)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:CATHERINE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19114 KANAWHA DR
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-9394
Mailing Address - Country:US
Mailing Address - Phone:832-451-0660
Mailing Address - Fax:980-206-0111
Practice Address - Street 1:19114 KANAWHA DR
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-9394
Practice Address - Country:US
Practice Address - Phone:832-451-0660
Practice Address - Fax:980-206-0111
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102825225X00000X
NC3388225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1952444101Medicaid
MN055588600Medicaid
MN961S7KEOtherBCBS
MNHP42429OtherHEALTH PARTNERS
MN6403492OtherMEDICA