Provider Demographics
NPI:1417317850
Name:ROSS, KENDRA (OT)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44560 WESTMINISTER WAY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2649
Mailing Address - Country:US
Mailing Address - Phone:734-865-0116
Mailing Address - Fax:
Practice Address - Street 1:44560 WESTMINISTER WAY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2649
Practice Address - Country:US
Practice Address - Phone:734-865-0116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-27
Last Update Date:2016-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002242225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist