Provider Demographics
NPI:1750112025
Name:JO, KENDALL NOELLE (OTR/L)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:NOELLE
Last Name:JO
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 1:8420 GAS HOUSE PIKE STE U
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4974
Mailing Address - Country:US
Mailing Address - Phone:240-651-0149
Mailing Address - Fax:
Practice Address - Street 1:8420 GAS HOUSE PIKE STE U
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4974
Practice Address - Country:US
Practice Address - Phone:240-651-0149
Practice Address - Fax:240-559-2624
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10333225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand