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General NPI Number Information
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NPI Number | 1225418619
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Entity Type | Individual
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Provider Name | KENDRA DEARK MOTR/L
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Gender | Female
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 1 SILVERCREST DR
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City | NEW ALBANY
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State | IN
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Zip | 47150-7800
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Country | US
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Telephone | 812-542-6720
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Fax |
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Provider Business Mailing Address
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Address Line | 2524 PALMETTO CT
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City | FLORENCE
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State | KY
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Zip | 41042-9047
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 31005860A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | BOTOCT00195836
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License Number State | KY
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