Provider Demographics
NPI:1861021701
Name:LOFTICE ROBERTS, KENDRA BRETT (OTR, CSRS, CBIS)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:BRETT
Last Name:LOFTICE ROBERTS
Suffix:
Gender:F
Credentials:OTR, CSRS, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 COUNTY ROAD 1300
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:TX
Mailing Address - Zip Code:75476-7003
Mailing Address - Country:US
Mailing Address - Phone:214-789-5703
Mailing Address - Fax:
Practice Address - Street 1:303 WALNUT ST
Practice Address - Street 2:
Practice Address - City:HOWE
Practice Address - State:TX
Practice Address - Zip Code:75459-4538
Practice Address - Country:US
Practice Address - Phone:903-744-4421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117134225X00000X, 225XN1300X
225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation