Provider Demographics
NPI:1508590050
Name:PIONTEK, KENDRA ANN (MS OTR/L CLT)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:ANN
Last Name:PIONTEK
Suffix:
Gender:F
Credentials:MS OTR/L CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2387 LANTERN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-4850
Mailing Address - Country:US
Mailing Address - Phone:317-750-9879
Mailing Address - Fax:
Practice Address - Street 1:2387 LANTERN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-4850
Practice Address - Country:US
Practice Address - Phone:317-750-9879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5516225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist