ELIZABETH PEDERSON OT
NPI 1669622411
Occupational Therapist in Appleton, WI

Active since September 29, 2008
1650 TRI PARK WAY, SUITE A, APPLETON, WI 54914(920) 830-6697(920) 830-6707 Get Directions Write a Review

NPPES record last updated: September 29, 2008. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Elizabeth Pederson Ot NPPES

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

ELIZABETH PEDERSON OT (NPI 1669622411) is an individual occupational therapist in Appleton, Wisconsin, licensed in Wisconsin (3622) and active in the NPI registry since September 2008.

NPPES Registry Identity

NPI1669622411
Entity TypeIndividualFemale
Primary Taxonomy225X00000X
Provider Legal NameELIZABETH PEDERSONCredential: OT
Location Address1650 TRI PARK WAY, SUITE AAppleton, WI 54914-1652
Mailing Address1650 Tri Park Way, Suite AAppleton, WI 54914-1652 · (920) 830-6697 · Fax (920) 830-6707
Fax(920) 830-6707
Sole ProprietorNo
Enumeration DateSeptember 29, 2008
✔ NPI 1669622411 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 WI · 3622✔ Licensed in MN · 103139
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.
1650 TRI PARK WAY, Appleton, WI 54914

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Elizabeth Pederson Ot is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignment

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

Physical Therapist
825 COBBLESTONE LN
Kimberly, WI 54136
  • Reassigned Medicare billing, Wisconsin and Minnesota enrollments
  • Also billed through NPI 1033611298 (Minnesota)
  • 63 clinicians in this Medicare group

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 19

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

Occupational Therapist
1650 TRI PARK WAY, SUITE A
APPLETON, WI 54914
Occupational Therapist
1650 TRI PARK WAY, SUITE A
APPLETON, WI 54914
Occupational Therapist
1650 TRI PARK WAY
APPLETON, WI 54914
Occupational Therapist
1650 TRI PARK WAY
APPLETON, WI 54914
Occupational Therapist
1650 TRI PARK WAY, SUITE A
APPLETON, WI 54914
Occupational Therapist
1650 TRI PARK WAY
APPLETON, WI 54914
Occupational Therapist
1650 TRI PARK WAY, SUITE A
APPLETON, WI 54914
Occupational Therapist
1650 TRI PARK WAY, SUITE A
APPLETON, WI 54914

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 Elizabeth Pederson's NPI number?

The NPI number for Elizabeth Pederson is 1669622411. It was assigned to this individual provider in the NPPES registry on September 29, 2008.

Where is Elizabeth Pederson located?

Elizabeth Pederson practices at 1650 Tri Park Way Suite A, Appleton, WI 54914. The listed phone number is (920) 830-6697.

What is Elizabeth Pederson's specialty?

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

Is Elizabeth Pederson enrolled in Medicare?

Yes. Elizabeth Pederson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Elizabeth Pederson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Elizabeth Pederson reassigns Medicare benefits to Aegis Group Practice LLC (Kimberly, WI). 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 Elizabeth Pederson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Elizabeth Pederson was last updated on September 29, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years 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.