Provider Demographics
NPI:1942841325
Name:QUEARRY, KENZY NOEL (COTA)
Entity Type:Individual
Prefix:MISS
First Name:KENZY
Middle Name:NOEL
Last Name:QUEARRY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13932
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-0932
Mailing Address - Country:US
Mailing Address - Phone:501-803-9722
Mailing Address - Fax:
Practice Address - Street 1:405 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6267
Practice Address - Country:US
Practice Address - Phone:501-803-9722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant