# ELISE ROSE LICHTENBERG PETERSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1194277749
- **Gender:** F
- **Credential:** MSOTR/L

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | 10143483-4201 | UT | Yes |

## Other

- **Enumeration date:** 10/31/2016
- **Last updated:** 03/24/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 942854057 | — | UT |