Provider Demographics
NPI:1437280591
Name:GRUBER, KENDRA KAY (OTR - L)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:KAY
Last Name:GRUBER
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 1:7210 HEATHER RD
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-9431
Mailing Address - Country:US
Mailing Address - Phone:610-336-9414
Mailing Address - Fax:
Practice Address - Street 1:7210 HEATHER RD
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-9431
Practice Address - Country:US
Practice Address - Phone:610-336-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC007277L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019276800003Medicaid