Provider Demographics
NPI:1548432040
Name:KENNEDY, JOSEPHINE KATHRYN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:KATHRYN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:JOSEPHINE
Other - Middle Name:KATHRYN
Other - Last Name:BOKARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3196 KENNEDY BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-2436
Mailing Address - Country:US
Mailing Address - Phone:201-223-4949
Mailing Address - Fax:
Practice Address - Street 1:3196 KENNEDY BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2436
Practice Address - Country:US
Practice Address - Phone:201-223-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00432100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist