Provider Demographics
NPI:1649496068
Name:EASTWOOD, KENDRA
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:
Last Name:EASTWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 163
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73062-9756
Mailing Address - Country:US
Mailing Address - Phone:580-343-2852
Mailing Address - Fax:
Practice Address - Street 1:106 WEST ADAMS STREET
Practice Address - Street 2:
Practice Address - City:CORN
Practice Address - State:OK
Practice Address - Zip Code:73024
Practice Address - Country:US
Practice Address - Phone:580-343-2852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK801224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant