Provider Demographics
NPI:1093346645
Name:JUSTICE, KENDRA (OTR/L)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 TICK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-7806
Mailing Address - Country:US
Mailing Address - Phone:740-250-9944
Mailing Address - Fax:
Practice Address - Street 1:380 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:BIDWELL
Practice Address - State:OH
Practice Address - Zip Code:45614-9215
Practice Address - Country:US
Practice Address - Phone:740-446-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist