Provider Demographics
NPI:1164529822
Name:RISINGER, KENDRA ANNETTE (OT)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:ANNETTE
Last Name:RISINGER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 PASEO DEL PUEBLO SUR # 328
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5972
Mailing Address - Country:US
Mailing Address - Phone:505-927-4379
Mailing Address - Fax:
Practice Address - Street 1:HWY 285 ROAD 111
Practice Address - Street 2:
Practice Address - City:OJO CALIENTE
Practice Address - State:NM
Practice Address - Zip Code:87549
Practice Address - Country:US
Practice Address - Phone:505-583-2645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1736225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics