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General NPI Number Information
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NPI Number | 1396541843
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Entity Type | Individual
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Provider Name | KENNEDY DENISE YOUNG COTA/L
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Gender | Female
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 720 OLD CHEROKEE RD
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City | LEXINGTON
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State | SC
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Zip | 29072-9406
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Country | US
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Telephone | 803-490-0960
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Fax |
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Provider Business Mailing Address
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Address Line | 124 SHORTCUT RD
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City | PELION
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State | SC
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Zip | 29123-9647
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Country | US
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Telephone | 803-944-8331
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 5335
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License Number State | SC
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