Provider Demographics
NPI:1932646890
Name:KENNEMER, ERICA (OTR/L, MOT, HPCS)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:KENNEMER
Suffix:
Gender:F
Credentials:OTR/L, MOT, HPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 S BOLDEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058
Mailing Address - Country:US
Mailing Address - Phone:682-229-4141
Mailing Address - Fax:501-475-1478
Practice Address - Street 1:385 US 65
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032
Practice Address - Country:US
Practice Address - Phone:501-697-9881
Practice Address - Fax:501-475-1478
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR 2947225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist