Provider Demographics
NPI:1639358997
Name:KENNEDY, ALLISON VARGAS (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:VARGAS
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:REBECCA
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:1157 FIRST COLONIAL RD STE 201
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2432
Practice Address - Country:US
Practice Address - Phone:757-481-0052
Practice Address - Fax:757-481-1099
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 12943225XP0200X, 225X00000X
VA0119006447225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL892541100Medicaid
FLZ152TOtherBCBS