Provider Demographics
NPI:1982948618
Name:CHEELY, KENDALL LYNN (OTR)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:LYNN
Last Name:CHEELY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6862
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29804-6862
Mailing Address - Country:US
Mailing Address - Phone:803-226-0146
Mailing Address - Fax:803-226-0197
Practice Address - Street 1:2250 WOODSIDE EXECUTIVE CT
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-3812
Practice Address - Country:US
Practice Address - Phone:803-226-0146
Practice Address - Fax:803-226-0197
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005545225X00000X
SC4049225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist