Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1263 | NC |
NPI | 1003094285 |
---|---|
Provider Name | Brenda Kennell |
First Address | Charlotte, NC 28210-4768 |
Second Address | Charlotte, NC 28210-4768 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2008 |
Last Update Date | 10/02/2008 |