Provider Demographics
NPI:1194048736
Name:KENDALL, JESSICA (ATC, LAT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KENDALL
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HAMMOND RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1910
Mailing Address - Country:US
Mailing Address - Phone:801-243-8901
Mailing Address - Fax:
Practice Address - Street 1:579 BURCALE RD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-8329
Practice Address - Country:US
Practice Address - Phone:801-243-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT671106148102255A2300X
SC11242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer