Provider Demographics
NPI:1700188638
Name:KENNEDY, CHRISTINE (COTA/L)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 LAKEVIEW DR.
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:ME
Mailing Address - Zip Code:04055
Mailing Address - Country:US
Mailing Address - Phone:850-217-3764
Mailing Address - Fax:
Practice Address - Street 1:37 LAKEVIEW DR.
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:ME
Practice Address - Zip Code:04055
Practice Address - Country:US
Practice Address - Phone:850-217-3764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9737224Z00000X
MEOA2632224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant