Provider Demographics
NPI:1770722928
Name:KENNEDY, DAVID E (OT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:E
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17800 CADDY DR
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1004
Mailing Address - Country:US
Mailing Address - Phone:240-997-3938
Mailing Address - Fax:
Practice Address - Street 1:17800 CADDY DR
Practice Address - Street 2:
Practice Address - City:DERWOOD
Practice Address - State:MD
Practice Address - Zip Code:20855-1004
Practice Address - Country:US
Practice Address - Phone:240-997-3938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04163225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist