Provider Demographics
NPI:1174644793
Name:KENDALL, AMY R (OTR)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:KENDALL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52160 FIELDSTONE LN
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9266
Mailing Address - Country:US
Mailing Address - Phone:574-315-3351
Mailing Address - Fax:574-272-1935
Practice Address - Street 1:52160 FIELDSTONE LN
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9266
Practice Address - Country:US
Practice Address - Phone:574-315-3351
Practice Address - Fax:574-272-1935
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002539A225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics