Provider Demographics
NPI:1295410538
Name:O'KELLEY, KENDALL STANALAND
Entity type:Individual
Prefix:MRS
First Name:KENDALL
Middle Name:STANALAND
Last Name:O'KELLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KENDALL
Other - Middle Name:STANALAND
Other - Last Name:O'KELLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1909 HILLBROOKE TRL STE 3
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-7902
Mailing Address - Country:US
Mailing Address - Phone:850-299-4862
Mailing Address - Fax:
Practice Address - Street 1:1909 HILLBROOKE TRL STE 3
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-7902
Practice Address - Country:US
Practice Address - Phone:486-285-0299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician