Provider Demographics
NPI:1346513413
Name:KENNO, ASTER
Entity Type:Individual
Prefix:MRS
First Name:ASTER
Middle Name:
Last Name:KENNO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 LEGAULT DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8332
Mailing Address - Country:US
Mailing Address - Phone:919-656-5484
Mailing Address - Fax:
Practice Address - Street 1:6590 TRYON RD
Practice Address - Street 2:CARY HEALTH AND REHAB
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-8332
Practice Address - Country:US
Practice Address - Phone:919-851-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6326224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant