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General NPI Number Information
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NPI Number | 1255276663
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Entity Type | Individual
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Provider Name | EMMA GRACE PETERSON
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Gender | Female
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Dates
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Enumeration Date | 04/22/2026
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Last Update Date | 04/22/2026
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Provider Practice Location Address
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Address Line | 7117 TUSSING RD
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-4108
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Country | US
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Telephone | 614-834-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 5550 PEACHTREE PKWY STE 500
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City | PEACHTREE CORNERS
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State | GA
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Zip | 30092-2555
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Country | US
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Telephone | 800-849-5502
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Fax | 770-908-2203
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 008726
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License Number State | OH
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