TEQUILA BREYONDA PETTY OT
NPI 1417723768
Occupational Therapist in Hickory, NC

Active since November 28, 2023
16 2ND ST NW, HICKORY, NC 28601(828) 358-0976(828) 838-1057 Get Directions Write a Review

NPPES record last updated: May 30, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Tequila Breyonda Petty Ot NPPES

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

TEQUILA BREYONDA PETTY OT (NPI 1417723768) is an individual occupational therapist in Hickory, North Carolina, licensed in North Carolina (16408) and active in the NPI registry since November 2023.

NPPES Registry Identity

NPI1417723768
Entity TypeIndividualFemale
Primary Taxonomy225X00000X
Provider Legal NameTEQUILA BREYONDA PETTYCredential: OT
Location Address16 2ND ST NWHickory, NC 28601-6105
Mailing AddressPo Box 749Belmont, NC 28012-0749
Fax(828) 838-1057
Sole ProprietorNo
Enumeration DateNovember 28, 2023
Last NPPES UpdateMay 30, 2024
NPPES CertifiedMay 30, 2024
✔ NPI 1417723768 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
License✔ Licensed in NC · 16408
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.
16 2ND ST NW, Hickory, NC 28601

Accepted Insurance

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tequila Breyonda Petty Ot is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignment

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

Physical Therapist
1244 N FLINT STREET
Lincolnton, NC 28092
  • Reassigned Medicare billing, North Carolina enrollment
  • 55 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 15

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

Interpreter
16 2ND ST NW
HICKORY, NC 28601
Behavior Technician
16 2ND ST NW
HICKORY, NC 28601
Speech-Language Pathologist
16 2ND ST NW
HICKORY, NC 28601
Behavior Analyst
16 2ND ST NW
HICKORY, NC 28601
Behavior Analyst
16 2ND ST NW
HICKORY, NC 28601
Behavior Analyst
16 2ND ST NW
HICKORY, NC 28601
Behavior Analyst
16 2ND ST NW
HICKORY, NC 28601
Behavior Technician
16 2ND ST NW
HICKORY, NC 28601

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 Tequila Petty's NPI number?

The NPI number for Tequila Petty is 1417723768. It was assigned to this individual provider in the NPPES registry on November 28, 2023.

Where is Tequila Petty located?

Tequila Petty practices at 16 2nd St NW, Hickory, NC 28601. The listed phone number is (828) 358-0976.

What is Tequila Petty's specialty?

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

Is Tequila Petty enrolled in Medicare?

Yes. Tequila Petty is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Tequila Petty's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Tequila Petty reassigns Medicare benefits to Kidology, Inc (Lincolnton, NC). 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 Tequila Petty's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Tequila Petty accept?

Health plans from Blue Cross and Blue Shield of NC list Tequila Petty as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Tequila Petty was last updated on May 30, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.