MEDICARE: MARY H KENDRICK

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	171W00000X	Contractor		OH

General Provider Information

NPI Number	:	1356294763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY H KENDRICK

Provider Business Mailing Address
First Line	:	2314 THEODORE AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-3434
Country	:	US
Telephone Number	:	937-309-3328
Fax Number	:	937-309-3328

Provider Business Practice Location Address
First Line	:	2314 THEODORE AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-3434
Country	:	US
Telephone Number	:	937-309-3328
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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Directions to “ MARY H KENDRICK ” Practice Location

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