Healthcare Provider Details

I. General information

NPI: 1649185828
Provider Name (Legal Business Name): KENNA MARIE KLEINERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 SWANSBORO ELEMENTARY SCHOOL RD
SWANSBORO NC
28584
US

IV. Provider business mailing address

9332 E 4500S RD
SAINT ANNE IL
60964-4090
US

V. Phone/Fax

Practice location:
  • Phone: 910-326-1501
  • Fax:
Mailing address:
  • Phone: 815-404-4215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: