Provider Demographics
NPI:1497559033
Name:REEVES, KENDAL TERESA (OTR/L)
Entity type:Individual
Prefix:
First Name:KENDAL
Middle Name:TERESA
Last Name:REEVES
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 1:1020 BRENTON DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2770
Mailing Address - Country:US
Mailing Address - Phone:678-832-7242
Mailing Address - Fax:
Practice Address - Street 1:1816 BRIARWOOD INDUSTRIAL CT NE STE A
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-1642
Practice Address - Country:US
Practice Address - Phone:404-636-5272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT009463225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics