Provider Demographics
NPI:1013498799
Name:KENNEDY, ANNE-MARIE FRASER (OTA)
Entity Type:Individual
Prefix:MS
First Name:ANNE-MARIE
Middle Name:FRASER
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:OTA
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 64027
Mailing Address - Street 2:
Mailing Address - City:PIPE CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:78063-4027
Mailing Address - Country:US
Mailing Address - Phone:210-663-2430
Mailing Address - Fax:
Practice Address - Street 1:222 FM 1077
Practice Address - Street 2:
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003-4765
Practice Address - Country:US
Practice Address - Phone:210-663-2430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212317224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant