Provider Demographics
NPI:1326598269
Name:KOESTERS, KENDRA JANELLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:JANELLE
Last Name:KOESTERS
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 1:3554 STATE ROUTE 219
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-8705
Mailing Address - Country:US
Mailing Address - Phone:419-953-4670
Mailing Address - Fax:
Practice Address - Street 1:1001 MYERS RD
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-1137
Practice Address - Country:US
Practice Address - Phone:419-586-6645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT009552225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist