Provider Demographics
NPI:1235558628
Name:KENNEDY, KATERRELL
Entity Type:Individual
Prefix:
First Name:KATERRELL
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 STATE ST
Mailing Address - Street 2:STE 5
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4727
Mailing Address - Country:US
Mailing Address - Phone:812-618-9284
Mailing Address - Fax:812-590-4131
Practice Address - Street 1:1222 STATE ST
Practice Address - Street 2:STE 3
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4879
Practice Address - Country:US
Practice Address - Phone:812-618-9284
Practice Address - Fax:812-590-4131
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist