Provider Demographics
NPI:1073818779
Name:BIGELOW, KENDRA Q (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:Q
Last Name:BIGELOW
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 S CAMPBELL AVE
Mailing Address - Street 2:2ND FLR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-1217
Mailing Address - Country:US
Mailing Address - Phone:636-439-9168
Mailing Address - Fax:
Practice Address - Street 1:6333 S CAMPBELL AVE
Practice Address - Street 2:2ND FLR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-1217
Practice Address - Country:US
Practice Address - Phone:636-439-9168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010032131171W00000X
IL057.003372224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant