Provider Demographics
NPI:1568832210
Name:MICHEL, KENDRA LEONA
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:LEONA
Last Name:MICHEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 SCHOOL LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-2866
Mailing Address - Country:US
Mailing Address - Phone:301-952-6000
Mailing Address - Fax:
Practice Address - Street 1:65 HERRINGTON DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1545
Practice Address - Country:US
Practice Address - Phone:301-808-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025382225X00000X
TX122616225X00000X
103K00000X
MD09776225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY969633146OtherUNITED HEALTHCARE