Kendyl Petty

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

2024016984 Issued in MO

Practice address

825 Pearl Ave
Joplin, MO 64801

Phone

(417) 625-5200

NPI assigned

Aug 25, 2025

Sex

Unspecified or another gender identity

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1756080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756080000000",
    "number": "1316825698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 HICKORY PL",
            "city": "CARL JUNCTION",
            "state": "MO",
            "postal_code": "648349531",
            "telephone_number": "417-437-4428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 PEARL AVE",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "64801",
            "telephone_number": "417-625-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "KENDYL",
        "sole_proprietor": "NO",
        "sex": "X",
        "enumeration_date": "2025-08-25",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MO",
            "license": "2024016984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heidi Jane Peterson, CRNA
• Jeannie Marie Peterson, CRNA
• Shawn Larae Peterson, PTA
• Henry D. Petry, DO
• Paul David Petry, D.O.
• Sean C Pfeffer, MD
• CHI Pham
• Hao Pham
• Tommy Phan, OTR/L
• Pharm Joplin Acquisition, LLC

• Occupational Therapy Assistant in Joplin, MO
• Providers in Joplin, MO by specialty
• Occupational Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.