Provider Demographics
NPI:1659549301
Name:OPOKU, KENNEDY RICHMOND (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:KENNEDY
Middle Name:RICHMOND
Last Name:OPOKU
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3808
Mailing Address - Country:US
Mailing Address - Phone:718-812-7082
Mailing Address - Fax:973-736-3989
Practice Address - Street 1:2 WINDING WAY
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-3808
Practice Address - Country:US
Practice Address - Phone:718-812-7082
Practice Address - Fax:973-736-3989
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013312-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist