Active NPI
Tyrone Penny Jr., RBT , ARF
- Mental Health Occupational Therapist
- Modesto, CA
National Provider Identifier
1477226876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Occupational Therapist
- License
- B6770816
- Practice address
- 564 Pirinen LN Apt C
Modesto, CA 95354-2010 - Phone
- (209) 486-5175
- NPI assigned
- Jul 30, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Occupational Therapist | 225XM0800X | B6770816 | CA | Primary |
Addresses
Primary practice location
564 Pirinen LN Apt C
Modesto, CA 95354-2010
Mailing address
12091 E Whitmore Ave
Modesto, CA 95236
Phone (209) 883-1201
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B6770816 | CA | MD | Mental Health Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627603200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627603200000",
"number": "1477226876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12091 E WHITMORE AVE",
"city": "MODESTO",
"state": "CA",
"postal_code": "95236",
"telephone_number": "209-883-1201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "564 PIRINEN LN APT C",
"city": "MODESTO",
"state": "CA",
"postal_code": "953542010",
"telephone_number": "209-486-5175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNY",
"first_name": "TYRONE",
"name_suffix": "Jr.",
"credential": "RBT , ARF",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-07-30",
"last_updated": "2021-07-30",
"certification_date": "2021-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "225XM0800X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Mental Health",
"state": "CA",
"license": "B6770816",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.