Healthcare Provider Details

I. General information

NPI: 1356618599
Provider Name (Legal Business Name): KENNEDY WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MILWAUKEE ST STE 308
DENVER CO
80206-5011
US

IV. Provider business mailing address

222 MILWAUKEE ST STE 308
DENVER CO
80206-5011
US

V. Phone/Fax

Practice location:
  • Phone: 303-322-5015
  • Fax:
Mailing address:
  • Phone: 303-322-5015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3050
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number3050
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number3050
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3050
License Number StateCO

VIII. Authorized Official

Name: NATHAN KENNEDY
Title or Position: OWNER
Credential: D.C.
Phone: 303-322-5015