MEDICARE: KENNEDY R OPOKU OCCUPATIONAL THERAPY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1205061298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNEDY R OPOKU OCCUPATIONAL THERAPY PC

Provider Business Mailing Address
First Line	:	2 WINDING WAY
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-3808
Country	:	US
Telephone Number	:	718-812-7012
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 WINDING WAY
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-3808
Country	:	US
Telephone Number	:	718-812-7012
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. KENNEDY OPOKU
Credential	:
Telephone Number	:	718-812-7082

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	05/20/2009

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