Healthcare Provider Details

I. General information

NPI: 1255259578
Provider Name (Legal Business Name): KENLEY EASTER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 NE GATEWAY CT NE
CONCORD NC
28025-2414
US

IV. Provider business mailing address

3100 ERSKINE DR
CHARLOTTE NC
28205-2026
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-9100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18008
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: