Provider Demographics
NPI:1669781506
Name:WILLIAMS, KENDRA ANN (MA OTR/L)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA OTR/L
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA OTR/L
Mailing Address - Street 1:2775 LEXINGTON AVE N
Mailing Address - Street 2:APT 115
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-2079
Mailing Address - Country:US
Mailing Address - Phone:612-437-2132
Mailing Address - Fax:
Practice Address - Street 1:3333 UNIVERSITY AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-3325
Practice Address - Country:US
Practice Address - Phone:612-728-5396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103909225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics