Provider Demographics
NPI:1275293847
Name:FOX, KYNDALL SAMANTHA (OTR/L)
Entity Type:Individual
Prefix:
First Name:KYNDALL
Middle Name:SAMANTHA
Last Name:FOX
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 S VILLA DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-3249
Mailing Address - Country:US
Mailing Address - Phone:812-568-2966
Mailing Address - Fax:
Practice Address - Street 1:3900 WASHINGTON AVE STE 100A
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0550
Practice Address - Country:US
Practice Address - Phone:812-485-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN225X00000X
IN31007619A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist