Provider Demographics
NPI:1114045143
Name:KENTON, JOANN OUTTEN (MS ATC)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:OUTTEN
Last Name:KENTON
Suffix:
Gender:F
Credentials:MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 CARPENTER BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19952-2969
Mailing Address - Country:US
Mailing Address - Phone:302-398-9294
Mailing Address - Fax:302-284-5833
Practice Address - Street 1:5407 KILLENS POND RD
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:DE
Practice Address - Zip Code:19943-1901
Practice Address - Country:US
Practice Address - Phone:302-284-9291
Practice Address - Fax:302-284-5833
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ3-00000852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer