Provider Demographics
NPI:1649583824
Name:KUYKENDALL, EDDIE LEELOVE III (COTA)
Entity type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:LEELOVE
Last Name:KUYKENDALL
Suffix:III
Gender:M
Credentials:COTA
Other - Prefix:
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Mailing Address - Street 1:7519 N 47TH LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-1576
Mailing Address - Country:US
Mailing Address - Phone:602-301-5592
Mailing Address - Fax:
Practice Address - Street 1:13835 N TATUM BLVD
Practice Address - Street 2:STE 9-429
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5590
Practice Address - Country:US
Practice Address - Phone:480-242-5903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3353224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant