Kiley Petencin
NPI 1639810823ActiveIndividual· Occupational Therapist· Idaho Falls, ID
Occupational Therapist with Holistic Community Therapy LLC, practicing in Idaho Falls, Idaho. Enrolled in Medicare as practitioner - occupational therapist in private practice and practitioner - occupational therapist in private practice.
Overview
| NPI | 1639810823 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | No |
| NPI issued | Apr 5, 2022 |
| Last updated in NPPES | Jul 27, 2026 |
| Certified by provider | Jul 27, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Occupational Therapist Primary | 225X00000X | OT-1736 | ID |
| Occupational Therapist | 225X00000X | 379227 | OR |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Occupational Therapist in Private Practice (ID); Practitioner - Occupational Therapist in Private Practice (OR) |
|---|
Education and affiliations
| Graduation year | 2016 |
|---|---|
| Medicare specialty | Occupational Therapist In Private Practice |
Medical group
- Holistic Community Therapy LLCPortland, OR · 4 clinicians
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All 41 occupational therapists in Idaho Falls · All occupational therapists in Idaho