Provider Demographics
NPI:1780216986
Name:KENDO, MARISA A (OT)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:A
Last Name:KENDO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9425 N NEVADA ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1286
Mailing Address - Country:US
Mailing Address - Phone:509-270-0065
Mailing Address - Fax:509-319-2520
Practice Address - Street 1:9425 N NEVADA ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-5014
Practice Address - Country:US
Practice Address - Phone:509-270-0065
Practice Address - Fax:509-319-2520
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61029052225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOT61029052Medicaid