Healthcare Provider Details

I. General information

NPI: 1649702002
Provider Name (Legal Business Name): KENDRA SUE PENNINGTON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
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: 918-836-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number292
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10681
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: