Healthcare Provider Details

I. General information

NPI: 1518700525
Provider Name (Legal Business Name): KENDRA PENNINGTON, OTR/L
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7915 S 77TH EAST AVE
TULSA OK
74133-3527
US

IV. Provider business mailing address

7915 S 77TH EAST AVE
TULSA OK
74133-3527
US

V. Phone/Fax

Practice location:
  • Phone: 918-409-2334
  • Fax:
Mailing address:
  • Phone: 918-409-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KENDRA PENNINGTON
Title or Position: PARTNER
Credential: OTR/L
Phone: 918-409-2334