Provider Demographics
NPI:1629192513
Name:KENDALL, NANCY G (NANCY KENDALL)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:G
Last Name:KENDALL
Suffix:
Gender:F
Credentials:NANCY KENDALL
Other - Prefix:MISS
Other - First Name:NANCY
Other - Middle Name:ALICE
Other - Last Name:GALBREATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:337 TROIS CT
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1112
Mailing Address - Country:US
Mailing Address - Phone:410-987-5528
Mailing Address - Fax:
Practice Address - Street 1:330 OAK MANOR DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5509
Practice Address - Country:US
Practice Address - Phone:410-222-6423
Practice Address - Fax:410-222-6424
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01239225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0937Medicaid