Provider Demographics
NPI:1043583172
Name:NOEL, KENDALL THERESA (COTA)
Entity Type:Individual
Prefix:MS
First Name:KENDALL
Middle Name:THERESA
Last Name:NOEL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 N SHERMAN CIR APT 102
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-2052
Mailing Address - Country:US
Mailing Address - Phone:239-867-6161
Mailing Address - Fax:
Practice Address - Street 1:8700 N SHERMAN CIR APT 102
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-2052
Practice Address - Country:US
Practice Address - Phone:239-867-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11838224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant