Provider Demographics
NPI:1780101980
Name:MARAIS, KENDRA MARIE (OTR)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:MARIE
Last Name:MARAIS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:MARIE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1422 W. WILLOW ST SUITE 100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642
Mailing Address - Country:US
Mailing Address - Phone:513-755-6600
Mailing Address - Fax:
Practice Address - Street 1:1422 W. WILLOW ST SUITE 100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642
Practice Address - Country:US
Practice Address - Phone:773-980-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
IL056.012091225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0406425Medicaid