Provider Demographics
NPI:1184204091
Name:BERA, KENDALL (OT)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:BERA
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 1:3823 E STATE ROAD 64
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-9041
Mailing Address - Country:US
Mailing Address - Phone:941-745-5111
Mailing Address - Fax:941-645-5667
Practice Address - Street 1:3823 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-9041
Practice Address - Country:US
Practice Address - Phone:941-745-5111
Practice Address - Fax:941-645-5667
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist