Provider Demographics
NPI:1851944342
Name:HYDE, KENDRA DANIELLE (60978136OTAOC)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:DANIELLE
Last Name:HYDE
Suffix:
Gender:F
Credentials:60978136OTAOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MEDCALF ST
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-3414
Mailing Address - Country:US
Mailing Address - Phone:858-472-8895
Mailing Address - Fax:
Practice Address - Street 1:800 MEDCALF ST
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563
Practice Address - Country:US
Practice Address - Phone:360-249-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60978136OTA.OC224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant