Provider Demographics
NPI:1740060250
Name:VANDERWOUDE, KENDRA JOY (OTR/L)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:JOY
Last Name:VANDERWOUDE
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 1:16401 BLACKBERRY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28107-9049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 LAMBERT RD
Practice Address - Street 2:
Practice Address - City:BISCOE
Practice Address - State:NC
Practice Address - Zip Code:27209-9002
Practice Address - Country:US
Practice Address - Phone:910-428-2117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15782225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology