Provider Demographics
NPI:1912166273
Name:RUTMAN, KENDRA MARIE
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:MARIE
Last Name:RUTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2749
Mailing Address - Country:US
Mailing Address - Phone:859-979-0954
Mailing Address - Fax:
Practice Address - Street 1:2615 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2749
Practice Address - Country:US
Practice Address - Phone:859-979-0954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist