KILEY PETENCIN
NPI 1639810823
Occupational Therapist in Idaho Falls, ID

Active since April 05, 2022Accepts Medicare Assignment
1460 ELK CREEK DR, IDAHO FALLS, ID 83404(208) 535-1286 Get Directions Write a Review

NPPES record last updated: July 27, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 27, 2026, Apr 5, 2022 (2 updates tracked since 2022).

About Kiley Petencin NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KILEY PETENCIN (NPI 1639810823) is an individual occupational therapist in Idaho Falls, Idaho, licensed in Idaho (OT-1736) and active in the NPI registry since April 2022. She is a graduate of Other (2016).

NPPES Registry Identity

NPI1639810823
Entity TypeIndividualFemale
Primary Taxonomy225X00000X
Provider Legal NameKILEY PETENCIN
Location Address1460 ELK CREEK DRIdaho Falls, ID 83404-8237
Mailing Address197 E 19th StIdaho Falls, ID 83404-6020 · (434) 825-4316
Sole ProprietorNo
Medical School CMSOtherGraduated 2016
Enumeration DateApril 5, 2022
Last NPPES UpdateJuly 27, 20262 updates tracked since enumeration
NPPES CertifiedJuly 27, 2026
✔ NPI 1639810823 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOccupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225X00000X
Licenses✔ Licensed in ID · OT-1736✔ Licensed in OR · 379227
Definition
An occupational therapist is a person who has graduated from an entry-level occupational therapy program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) or predecessor organizations, or approved by the World Federation of Occupational Therapists (WFOT), or an equivalent international occupational therapy education program; has successfully completed a period of supervised fieldwork experience required by the occupational therapy program; has passed a nationally recognized entry-level examination for occupational therapists, and fulfills state requirements for licensure, certification, or registration. An occupational therapist provides interventions based on evaluation and which emphasize the therapeutic use of everyday life activities (i.e., occupations) with individuals or groups for the purpose of facilitating participation in roles and situations and in home, school, workplace, community and other settings. Occupational therapy services are provided for the purpose of promoting health and wellness and are provided to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Occupational therapists address the physical, cognitive, psychosocial, sensory, and other aspects of occupational performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life.
1460 ELK CREEK DR, Idaho Falls, ID 83404

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kiley Petencin is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3971968769
PECOS Enrollment IDI20230501001390, I20240924004474

Medicare Billing Reassignment

Medicare enrollment records show Kiley Petencin reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Mental Health
1336 NW FLANDERS ST
Portland, OR 97209
  • Reassigned Medicare billing, Idaho and Oregon enrollments

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Occupational Therapist (Pediatrics)
1460 ELK CREEK DR
IDAHO FALLS, ID 83404
Speech-Language Pathologist
1460 ELK CREEK DR
IDAHO FALLS, ID 83404
Speech-Language Pathologist
1460 ELK CREEK DR
IDAHO FALLS, ID 83404
Speech-Language Pathologist
1460 ELK CREEK DR
IDAHO FALLS, ID 83404
Occupational Therapist (Pediatrics)
1460 ELK CREEK DR
IDAHO FALLS, ID 83404
Speech-Language Pathologist
1460 ELK CREEK DR
IDAHO FALLS, ID 83404
Occupational Therapist (Pediatrics)
1460 ELK CREEK DR
IDAHO FALLS, ID 83404
Occupational Therapist
1460 ELK CREEK DR
IDAHO FALLS, ID 83404

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kiley Petencin's NPI number?

The NPI number for Kiley Petencin is 1639810823. It was assigned to this individual provider in the NPPES registry on April 5, 2022.

Where is Kiley Petencin located?

Kiley Petencin practices at 1460 Elk Creek Dr, Idaho Falls, ID 83404. The listed phone number is (208) 535-1286.

What is Kiley Petencin's specialty?

The primary specialty registered for this NPI is Occupational Therapist with taxonomy code 225X00000X.

Is Kiley Petencin enrolled in Medicare?

Yes. Kiley Petencin is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Kiley Petencin's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kiley Petencin reassigns Medicare benefits to Holistic Community Therapy LLC (Portland, OR). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kiley Petencin's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kiley Petencin accept?

Health plans from BridgeSpan Health Company, PacificSource Health Plans and Regence BlueCross BlueShield of Oregon list Kiley Petencin as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kiley Petencin was last updated on July 27, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.