MEDICARE: JILLIAN REBEKAH PETERSON MS, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	8242	CA

General Provider Information

NPI Number	:	1639323165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN REBEKAH PETERSON MS, OTR/L

Provider Business Mailing Address
First Line	:	2834 CONGRESS RD
Second Line	:
City	:	PEBBLE BEACH
State	:	CA
Zip	:	93953-3107
Country	:	US
Telephone Number	:	858-866-6228
Fax Number	:

Provider Business Practice Location Address
First Line	:	2834 CONGRESS RD
Second Line	:
City	:	PEBBLE BEACH
State	:	CA
Zip	:	93953-3107
Country	:	US
Telephone Number	:	858-866-6228
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	04/25/2024

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