Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Nicole Marie Petruso, OTR

Individual provider Pediatric Occupational Therapist · NPI 1629560990

Nicole Marie Petruso, OTR is a Pediatric Occupational Therapist in LA Mesa, California. Licensed in California. Registered with an NPI since 2018.

Licensed in
CA
In the registry since
2018
What do these letters mean?
OTR — Occupational Therapist, Registered
A nationally registered occupational therapist.

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Practice location Address checks out

8030 La Mesa Blvd # 416
LA Mesa, CA 91942-0335
Phone: (619) 567-9448
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Occupational Therapist (primary) Taxonomy 225XP0200X · Licence 26623 (CA)

Record details

NPI number1629560990
Entity typeIndividual (Type 1)
GenderFemale
Credentials OTR
Sole proprietorNo
NPI enumeratedJune 3, 2018
Last updated in NPPESNovember 15, 2024
Certification dateNovember 15, 2024

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