Provider Demographics
NPI:1417314568
Name:KENNARD, MELISSA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:KENNARD
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 1:148 CAMELOT CT
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KY
Mailing Address - Zip Code:41169-1624
Mailing Address - Country:US
Mailing Address - Phone:740-357-5408
Mailing Address - Fax:
Practice Address - Street 1:100 WURTLAND AVE
Practice Address - Street 2:
Practice Address - City:WURTLAND
Practice Address - State:KY
Practice Address - Zip Code:41144-1445
Practice Address - Country:US
Practice Address - Phone:606-836-0931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3507225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist