Provider Demographics
NPI:1790272649
Name:ORR, KENDRA B
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:B
Last Name:ORR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19330 MONTEREY AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1503
Mailing Address - Country:US
Mailing Address - Phone:216-754-9604
Mailing Address - Fax:
Practice Address - Street 1:4119 CLYBOURNE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-3233
Practice Address - Country:US
Practice Address - Phone:216-754-9604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0246537Medicaid