Provider Demographics
NPI:1063267839
Name:TILLMAN, KENDALL L (MA, OTR/L)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:L
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 E JEFFERSON AVE APT 8C
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1544
Mailing Address - Country:US
Mailing Address - Phone:303-854-8068
Mailing Address - Fax:
Practice Address - Street 1:8500 E JEFFERSON AVE APT 8C
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-1544
Practice Address - Country:US
Practice Address - Phone:303-854-8068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist