Provider Demographics
NPI:1245843267
Name:THIRY, KENDALL (OTR/L)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:THIRY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6233 DURAND AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4961
Mailing Address - Country:US
Mailing Address - Phone:262-497-7270
Mailing Address - Fax:877-540-0135
Practice Address - Street 1:N2740 FRENCH RD
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:WI
Practice Address - Zip Code:54913-8919
Practice Address - Country:US
Practice Address - Phone:920-349-5314
Practice Address - Fax:877-540-0135
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6711-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist