Provider Demographics
NPI:1467881623
Name:VOGEL, KENDRA (OT)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:
Last Name:VOGEL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:KENDAR
Other - Middle Name:
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:400 S KENNEDY DR
Practice Address - Street 2:SUITE 500
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-2682
Practice Address - Country:US
Practice Address - Phone:815-936-0400
Practice Address - Fax:815-936-0416
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009349225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400163305Medicare PIN