Healthcare Provider Details

I. General information

NPI: 1124799358
Provider Name (Legal Business Name): KENDRA PRYOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7540 N 19TH AVE STE 200
PHOENIX AZ
85021-7967
US

IV. Provider business mailing address

7540 N 19TH AVE STE 200
PHOENIX AZ
85021-7967
US

V. Phone/Fax

Practice location:
  • Phone: 888-873-4221
  • Fax:
Mailing address:
  • Phone: 888-873-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: