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Individual

JENNIFER A PETERSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.T.R.

Contact information

Practice address
324 ROXBURY RD, ROCKFORD, IL 61107-5090
(815) 381-7431
(815) 381-7498
Mailing address
BOX 78534, MILWAUKEE, WI 53278
(815) 381-7431
(815) 381-7498

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
057-002477
IL
225X00000X
Occupational Therapist
Primary
056-010596
IL

Other

Enumeration date
04/15/2014
Last updated
12/11/2014
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