Provider Demographics
NPI:1710268891
Name:KENNEDY, JESSICA (MS, OT/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MS, OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04021-3707
Mailing Address - Country:US
Mailing Address - Phone:207-829-8007
Mailing Address - Fax:207-829-8008
Practice Address - Street 1:85 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:ME
Practice Address - Zip Code:04021-3707
Practice Address - Country:US
Practice Address - Phone:207-829-8007
Practice Address - Fax:207-829-8008
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
METO2555225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics