Provider Demographics
NPI:1932445293
Name:DECKER, KENDRA (COTA)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:DECKER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:RAMICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11214 OSAGE CIR UNIT A
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-4767
Mailing Address - Country:US
Mailing Address - Phone:303-870-1994
Mailing Address - Fax:
Practice Address - Street 1:4686 E ASBURY CIR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4723
Practice Address - Country:US
Practice Address - Phone:303-756-1566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
303792224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant