Provider Demographics
NPI:1689966863
Name:KENNEDY, SARAH (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
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 1:260 E CHASE AVENUE, NO. 204
Mailing Address - Street 2:SMALLTALK SPEECH THERAPY
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020
Mailing Address - Country:US
Mailing Address - Phone:314-422-0984
Mailing Address - Fax:
Practice Address - Street 1:260 E CHASE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-6325
Practice Address - Country:US
Practice Address - Phone:314-422-0984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11771225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist