Individual provider Active NPI

Kenlynne Ralph, OT

  • Occupational Therapist
  • Tempe, AZ
National Provider Identifier
1770858433
Registry record updated Apr 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
5080 Issued in AZ
Practice address
1930 E Southern Ave
Tempe, AZ 85282-7518
Phone
(480) 456-0719
NPI assigned
Mar 14, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 17, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 5080 AZ Primary

Addresses

Primary practice location

1930 E Southern Ave
Tempe, AZ 85282-7518

Mailing address

1930 E Southern Ave
Tempe, AZ 85282-7518
Phone (480) 456-0719

Other identifiers 1

IdentifierTypeStateIssuer
683253MedicaidAZ

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

LicenseStateTypeSpecialty
5080AZMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Pioneer Pet, LLC Past Accepting new patients
Solace Pediatric Healthcare Therapy Services Az, Inc. Occupational Therapist PastSince Jan 1, 1995 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1331683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334620800000",
    "number": "1770858433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 E SOUTHERN AVE",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852827518",
            "telephone_number": "480-456-0719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 E SOUTHERN AVE",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852827518",
            "telephone_number": "480-456-0719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RALPH",
        "first_name": "KENLYNNE",
        "credential": "OT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-14",
        "last_updated": "2012-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "AZ",
            "license": "5080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "683253",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tempe, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2012; 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.