Provider Demographics
NPI:1982768057
Name:HUNTER, KENDYL BROCK (OT)
Entity Type:Individual
Prefix:
First Name:KENDYL
Middle Name:BROCK
Last Name:HUNTER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KENDYL
Other - Middle Name:RUDD
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:105 NORTH MAIN STREET
Practice Address - Street 2:SUITES C & D
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528
Practice Address - Country:US
Practice Address - Phone:706-219-4507
Practice Address - Fax:706-865-1501
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT001075225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116807Medicare ID - Type Unspecified